RN, Care Coordinator (Marion County) M-TH 4/10s

Chapters Health; Ocala (FL); On-site; USD 61,860 - 96,657; Full time

Benefits offered by this job

Competitive salary

Comprehensive benefits package

Supportive work environment

Job summary

Chapters Health in Ocala, Florida, is seeking a dedicated RN Case Manager responsible for assessing and addressing patient and family needs. You'll work closely with the Interdisciplinary Team to ensure comprehensive care, providing clinical and supportive assistance to enhance patient quality of life.

The ideal candidate should possess a valid RN license, experience in hospice or hospitals, and a passion for patient care. This role offers a competitive salary range of $61,860.66 - $96,657.28 and contributes meaningfully to patient health in the community.

Qualifications

• Minimum of one year nursing experience; hospice or hospital experience preferred.
• Ability to visit participants in their homes for assessments.
• Active BLS certification from recognized authority.

Responsibilities

• Assess and identify patient/family needs in a home environment.
• Coordinate Plan of Care with the Interdisciplinary Team (IDT).
• Provide clinical, palliative, and supportive care to patients.

Skills

Clinical nursing skills

Communication (verbal and written)

EMR/EHR system experience

Compassion and empathy

BLS certification

Education

Current RN license in Florida

BLS for healthcare professionals

Job description

It’s inspiring to work with a company where people truly BELIEVE in what they’re doing! When you become part of the Chapters Health Team, you’ll realize it’s more than a job. It’s a mission. We’re committed to providing outstanding patient care and a high level of customer service in our communities every day. Our employees make all the difference in our success.

Job Profile Summary

Role: The RN, Case Manager is responsible for assessing and identifying patient/family needs, utilizing the nursing process, coordinating the Plan of Care with the Interdisciplinary Team (IDT), and providing clinical, palliative and supportive care to the patient/family unit in order to keep the participant in their home environment as long as possible.

Qualifications

• Current license as RN in the state where the employee will be working
• Minimum of one (1) year nursing experience; hospice or hospital experience preferred
• Employees working at PACE, certification of completion of Alzheimer's Disease and Related Dementias Training through the Florida Department of Elder Affairs
• Previous experience working with an EMR/EHR system
• Mobile Driver with valid driver’s license and automobile insurance per Company policy
• Reliable transportation to meet visit schedule
• Ability to use equipment with visual and auditory mechanisms
• Ability to effectively communicate in English (verbal and written)
• Ability to visit Participant in their homes for assessments
• Ability to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodation
• Active BLS for healthcare professionals from the American Heart Association or Red Cross

Additional Requirements (Some Locations)

• Provide reassurance on the phone to patients and families, assist in finding solutions to their questions and/or recognize the need for an in‑person visit, and coordinate in‑person visit when needed or requested
• Utilize appropriate support/expert resources or personnel to resolve complex or difficult situations
• Document patient/family contact information in the EMR and communicate with the Interdisciplinary Team (IDT)
• Complete initial and semi‑annual assessment for all Company services including, but not limited to: explain services to patients/families, address questions regarding patient needs, fears and physical limitations, present services in an empathetic and compassionate manner, provide information to Physicians and other IDT members, initiate Plan of Care, initiate skilled nursing interventions to enhance prevention, prevent complications, alleviate symptoms and maximize physical and emotional comfort, obtain Physician orders, and complete documentation per Company policy

Responsibilities

• Acts as the Company representative at assigned facilities while facilitating referrals to all service lines; works closely with referring hospitals, physicians, facilities, patients, families, and the general public
• Communicates frequently with other members of the IDT
• Provides all necessary clinical communication timely using SBAR
• Discusses any potential needs with after‑hours staff
• Develops strong relationships with case managers, physicians, etc. at facilities
• Provides and manages direct care to patients and families as part of IDT, incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow‑up
• Coordinates the Plan of Care, ensuring that an individualized Plan of Care is developed that accurately reflects the patient’s evolving needs
• Educates patient, family, caregivers and other health professionals about disease process and decline, prevention, palliative interventions, caregiving, dying process and safety practices
• Participant visit frequency dependent on risk score/needs to be determined
• Home visits to assess home safety, medication compliance, nutritional compliance, DME compliance—ability to live safely in the community
• Reports changes in the patient’s condition to appropriate members of the IDT or other health professionals
• Participates with the IDT to evaluate hospice referrals/admissions for level of care appropriateness, attends daily IDT collaboration meetings, presents concise and pertinent oral and written reports to IDT; respects and encourages input from all disciplines
• Communicates accurately and completely to physicians, staff members, patients, families, and supervisors; utilizes positive approaches when working with others
• Supervises patient care provided by Community Health Workers and Home Health Aides as requested
• During times of emergencies (i.e. Hurricanes, etc.), may be required to report to work at a location designated by the company to ensure continuity of services
• Performs other duties as assigned

Competencies

• Satisfactorily complete competency requirements for this position

Professional Expectations

• Represent the Company professionally at all times through care delivered and/or services provided to all clients
• Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse
• Comply with Company policies, procedures and standard practices
• Observe the Company’s health, safety and security practices
• Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company
• Use resources in a fiscally responsible manner
• Promote the Company through participation in community and professional organizations
• Participate proactively in improving performance at the organizational, departmental and individual levels
• Improve own professional knowledge and skill level
• Advance electronic media skills
• Support Company research and educational activities
• Share expertise with co‑workers both formally and informally
• Participate in Quality Assessment and Performance Improvement activities as appropriate for the position

Physical Demands

While performing the duties of this job, the following abilities are required: see; hear; talk; walk; use hands to finger, handle or feel. Frequently required to: stand; sit; reach with hands/arms; lift; bend; balance. Occasionally required to: pull; push; stoop/crouch; kneel; climb stairs.

Compensation and Benefits

Compensation Pay Range: $61,860.66 - $96,657.28

This position requires consent to drug and/or alcohol testing after a conditional offer of employment is made, as well as ongoing compliance with the Drug‑Free Workplace Policy. All Chapters Health System employees performing services for Florida affiliates are submitted through the Florida Care Provider Background Screening Clearinghouse to verify eligibility after a conditional offer of employment is made as well as ongoing eligibility.