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Summa Health at Home seeks a Registered Nurse Case Manager to lead patient assessments, plan individualized home-based care, and educate families. You will coordinate care with physicians and an interdisciplinary team to improve outcomes and quality of life in patients' homes.
The role emphasizes autonomous scheduling, efficient time management, and adherence to state practice guidelines while supporting a compassionate care approach.
As a Registered Nurse Case Manager (RNCM) you will make a difference in the lives of our patients. Our nurses give our patients the greatest gift – the ability to spend enhanced quality time with their loved ones in their preferred environment.
As a RNCM you will have the opportunity to provide one on one patient care and work at the top of your license. You will utilize your leadership skills in coordinating care and provide home-based nursing care for patients as directed by an attending physician. You’ll be part of an interdisciplinary team that focuses on providing compassionate quality care and producing positive outcomes for your patient population. Interacting with patients’ families while caring for your patients and experiencing the rewarding privilege to be part of every step of their recovery journey. Home care provides context and real-world perspective about what will really help patients restore their health.
You’ll assume ultimate accountability and leadership for the assessment of the patient condition and plan of care. You will case manage and provide clinical care under the direction of the physician. You’ll educate patients and their family members and ensures the safety of the patient. You will work autonomously, so you need to be efficient in managing your time. You’ll be responsible for all practices and duties within the scope of practice outlined by the state.
Plan of Care: Observe and monitor patient conditions and perform OASIS assessments (If you don’t already know this assessment, we will teach you!) to develop an individualized care plan and adjust as needs change.
Minimize Patient Risk: Administer medication as prescribed by the physician and help decrease re-hospitalizations by prioritizing visits for high-risk patients.
Supervision: Oversee and supervise total care of patient provided by nurse aides and LPNs
Continuity of Care: Manage multi-disciplinary care as applicable while promoting continuity of care with appropriate admissions, transfers, and discharges.
Family Educator/Advocate: Educate the patient and family on the disease process using teach back methods to ensure patient and family understanding.
Policies: Complete all clinical documentation following agency protocol and Medicare/Federal guidelines. Collaborate with the interdisciplinary team and physicians to ensure optimal care is provided.
Rules and Regulations: Understand and follow agency policies, procedures, rules, and regulations and communicate changes in schedule/availability to schedulers or supervisors.
Operations: Attend in-service training and mandatory agency meetings
We are proud to be part of the Alternate Solutions Health Network family.
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This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice.
We are an Equal Opportunity Employer.