Registered Nurse RN Care Manager Home Health

The Home Health Registered Nurse (RN) Care Manager is a professional nurse who coordinates and directs the home care patients care based on individual patient needs. The RN Care Manager is responsible for independent management of the Home Health patient population requiring the use of advanced assessment, teaching and decision-making skills. The nurse is responsible for ensuring that appropriate referrals to other services are made, interdisciplinary conferencing takes place regularly, and appropriate documentation is completed. Relevant knowledge and experience is consistently applied to new patient populations. The Care Manager cares for a caseload of home health patients by evaluating the patient for appropriateness of home health and developing the home care plan in conjunction with the physician. S/he educates patients, families, caregivers and community providers to safely perform care. S/he provides follow up by evaluating effectiveness of the home care plan, and monitoring patient/familys response to the plan to achieve patient/family goals and top decile outcomes. The Care Manager also identifies performance improvement and home health standard of care initiatives and assists to design or implement programs to address needed changes.

The value you'll bring to the team: Coordinates and directs the care of a caseload of home patients when the primary skill needed is nursing. Provides comprehensive assessment, planning, implementation and evaluation for that caseload as the primary nurse. Sets priorities of home care caseload adapting to the changing needs of the home care patients and families. Optimizes schedule daily to support productivity, efficiency and maintain best practice visit utilization. Assesses physical, functional, psychosocial, social, spiritual, educational, developmental, cultural, cognitive status and discharge planning needs of the home care patient utilizing interview observations and physical exam techniques. Assesses the home environment for safety, infection control, and community resource needs. Reviews patient history and physical, diagnostics and laboratory data. Reviews available information obtained by other team members. Reports abnormal items and results to the physician as appropriate and reviews with patient family. Accurately and timely documents these assessments. Utilizing assessment data, formulates a patient specific plan of care along with the patient, family and physician which is feasible within the physical, financial and emotional resources of the family. Establishes individualized, realistic, measurable patient centered goals in consultation with the patient, family and other health care providers including goals to improve or stabilize patients medical condition, functional abilities and promote independence. Considers the physical, cultural, psychosocial, spiritual, age specific and educational needs of the patient when developing the plan of care. Implements the plan of care through direct patient care, coordination, delegation and supervision of the activities of the health care team. Provides care based on physicians orders, in compliance with policies and procedures, standards of care, and regulatory requirements. Delegates appropriately and provides nursing supervision in the provision of care to patients by other licensed nurses and other personnel. Promotes continuity of care by accurately and completely communicating to other caregivers the status of patient for whom care is provided. Provides skilled nursing care, preventative rehabilitative procedures, and prescribed treatments with a variety of patient populations within various potentially complex home situations. Qualifications The expertise and experiences you'll need to succeed: EDUCATION AND EXPERIENCE REQUIRED: Minimum of one-year relevant clinical RN experience EDUCATION AND EXPERIENCE PREFERRED: Recent, relevant experience in a Medicare-certified home health agency as a case-manager Bachelors degree in nursing LICENSURE, CERTIFICATION OR REGISTRATION REQUIRED: Current Registered Nursing License in State of Practice Valid Drivers License and current car insurance Active American Heart Association BLS

• Coordinates and directs the care of a caseload of home patients when the primary skill needed is nursing.
• Provides comprehensive assessment, planning, implementation and evaluation for that caseload as the primary nurse.
• Sets priorities of home care caseload adapting to the changing needs of the home care patients and families. Optimizes schedule daily to support productivity, efficiency and maintain best practice visit utilization.
• Assesses physical, functional, psychosocial, social, spiritual, educational, developmental, cultural, cognitive status and discharge planning needs of the home care patient utilizing interview observations and physical exam techniques. Assesses the home environment for safety, infection control, and community resource needs. Reviews patient history and physical, diagnostics and laboratory data.
• Reviews available information obtained by other team members. Reports abnormal items and results to the physician as appropriate and reviews with patient family.
• Accurately and timely documents these assessments.
• Utilizing assessment data, formulates a patient specific plan of care along with the patient, family and physician which is feasible within the physical, financial and emotional resources of the family.
• Establishes individualized, realistic, measurable patient centered goals in consultation with the patient, family and other health care providers including goals to improve or stabilize patients medical condition, functional abilities and promote independence.
• Considers the physical, cultural, psychosocial, spiritual, age specific and educational needs of the patient when developing the plan of care.
• Implements the plan of care through direct patient care, coordination, delegation and supervision of the activities of the health care team. Provides care based on physicians orders, in compliance with policies and procedures, standards of care, and regulatory requirements.
• Delegates appropriately and provides nursing supervision in the provision of care to patients by other licensed nurses and other personnel.
• Promotes continuity of care by accurately and completely communicating to other caregivers the status of patient for whom care is provided.
• Provides skilled nursing care, preventative rehabilitative procedures, and prescribed treatments with a variety of patient populations within various potentially complex home situations.

• Minimum of one-year relevant clinical RN experience
• Current Registered Nursing License in State of Practice
• Valid Drivers License and current car insurance
• Active American Heart Association BLS

• Benefits from Day One
• Paid Days Off from Day One
• Career Development
• Whole Person Wellbeing Resources

Every day, our fellow team members show up to work, unified by one shared mission: Extending the Healing Ministry of Jesus Christ. As a faith-based health care organization, our story is one of hope as we strive to heal and restore the body, mind and spirit. Though our facilities are spread across the country, this unwavering belief binds us together. Across every office, exam and patient room, we’re committed to providing individualized, holistic care. This is our Christian mission, and it inspires us to help make communities healthier and happier.

Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.