RN – Case Manager

RN Case Manager

U.S. Medical Management (USMM) is an affiliate of a leading Fortune 100 company. A national organization built on a continuum of care with premier healthcare providers, clinicians and patient focused individuals working together. Our Mission – “Through Compassionate Patient-Centered Care in the Home; We will Provide Exceptional Outcomes across our Continuum of Services” – Visiting Physicians Association, Pinnacle Senior Care, Grace Hospice, Comfort Hospice, Home DME & our In Home Health Assessments (IHA).

Our Values of Integrity, Respect, Teamwork & Excellence are leading us to a better tomorrow for patient care. Our Purposes Centered on “We are Unified in our Work through our Continuum of Services” “We can Find Comfort that We are Making a Difference for our Patients” & “We make a Broader Positive Impact on Society”, allows USMM to be poised for a phenomenal future.

We are seeking candidates who desire the experience of delivering quality & compassionate healthcare within proven care models with patients at the forefront of everything we do.

Benefits We Have to Offer:

• Health, Dental, Vision, Disability & Life Insurance
• 401K Retirement Plan
• Paid Holidays
• PTO
• Flexible Spending Account
• Tuition Reimbursement

Position Description

Under the general supervision of the Clinical Supervisor/Clinical Manager, the RN – Case Manager provides intermittent skilled nursing services; communicates the patient’s progress with other disciplines and directs, supervises and instructs non-professional home health aide staff in the provision of personal care to the patient.

Job Requirements:

Essential Duties and Responsibilities

• Under the Physician’s order, admits patients eligible for home care services within 24-48 hours
• Assesses and evaluates patient needs/problems, identifies mutually agreed upon goals with patients
• Reports patient status and need for other disciplines to agency Clinical Supervisor and referring Physician
• Reports to assigned follow-up Clinician as indicated
• Develops patient care plan that specifically addresses identified patient problems; patient problems and goals
• Updates care plans on an ongoing basis; revises and resolves patient problems and goals as changes occur and/or at recertification
• Completes admission paperwork and patient care plan submitted to Clinical Supervisor per agency policy following the admission including completed and signed admission checklist
• Provides intermittent Skilled Nursing services including assessment, evaluation, procedures, teaching, and training activities as outlined in the patient Plan of Care
• Provides Skilled Nursing visits according to visit schedule and notifies agency of need to alter schedule in any way
• Reports significant findings to patient’s Physician and Clinical Supervisor as they occur
• Submits completed skilled nursing visit notes; communication notes and home health aide supervisory notes per agency policy on designated days as requested by Clinical Supervisor
• Submits change orders per agency policy
• Performs all OASIS time point assessment per Medicare Criteria and submits recertification paperwork per agency policy and procedure
• Maintains open lines of communications to all members of the continuum of care team.
• Supervises Home Health Aide and license and documents per Medicare criteria and per agency policy and procedure
• Acts as a preceptor in the orientation of new nursing staff as requested
• Attends staff meetings, team conferences and educational in-services per agency requirements
• Participates in Process Improvement (PI) program by assisting with collection of data and serves on PI team upon request
• Participates in discharge planning process Medicare Criteria and agency policy and procedure
• Follows agency policies and procedures
• Performs these and all other duties as assigned by the Administrator
• Able to lift 40 pounds from floor to shoulder
• Repetitive walking, standing, sitting, bending, and use of hands
• Able to drive a car 2-4 hours per day

REQUIRED Knowledge, Skills, and Experience

• Current unencumbered State Professional Nurse License
• Automobile to be used for work, current driver’s license, good driving record, and proof of insurance
• The ability to make sound professional clinical judgment
• The ability to assess and document patient needs and formulate individualized patient care plans to meet those needs
• Proficient clinical skills
• Excellent verbal and written communication skills
• Proficiency in personal computer use, including e-mail, clinical, word processing, spreadsheet, and presentation software

Preferred Knowledge, Skills, and Experience

• One year of experience as a home care professional nurse and is competent in performing home care comprehensive assessment