Geriatric Case Manager RN — Home Health Leader

Rochester Regional Health; United States; On-site; USD 76,000 - 101,000; Full time

Job summary

Rochester Regional Health Home Care is seeking a Geriatric Case Manager to deliver comprehensive nursing care under the GSV program. The RN will conduct pre-surgical assessments, identify post-discharge needs, and develop, implement, and evaluate an appropriate Plan of Care with patients and families.

The role coordinates interdisciplinary services, supervises care delivery, and ensures patient-centered outcomes while supporting program growth and quality improvement in a home-based setting.

Qualifications

• Associates Degree in Nursing required.
• Minimum 2 years nursing experience in home care or geriatric case management.
• Registered Nurse license in New York State.
• Valid NYS Driver’s License.
• Master’s in Nursing: Healthcare Leadership or Geriatric NP preferred.

Responsibilities

• Conducts Comprehensive Assessments of older adults’ physical, emotional, cognitive, and social needs, including pre-surgical in-home evaluations and post-discharge follow-up, with a focus on identifying and addressing Social Determinants of Health.
• Develops and Implements Interdisciplinary Care Plans in collaboration with patients, caregivers, and healthcare teams to support recovery and independence in the least restrictive setting.
• Coordinates and Monitors Care by navigating health systems, ensuring timely services, tracking patient progress, and adjusting care plans as needed to meet individual goals.
• Responds to Health Crises and Advocates for Patients, addressing emergencies like hospitalizations and ensuring high-quality, patient-centered care aligned with individual preferences.
• Provides Leadership and Quality Oversight, including supervising care teams, mentoring new staff, documenting thoroughly, participating in quality improvement, and supporting program growth.

Skills

Nursing

Education

Associates Degree in Nursing

Job description

Rochester Regional Health Home Care is seeking a Geriatric Case Manager to deliver comprehensive nursing care under the GSV program. The RN will conduct pre-surgical assessments, identify post-discharge needs, and develop, implement, and evaluate an appropriate Plan of Care with patients and families.

The role coordinates interdisciplinary services, supervises care delivery, and ensures patient-centered outcomes while supporting program growth and quality improvement in a home-based setting.