Registered Nurse
2 weeks ago
Description
JOB SUMMARY
The RN Case Manager is responsible for case managing patients assigned to them by ensuring coordination amongst home health disciplines to meet quality outcomes and moving the patient toward meeting their health goals and a state of independence. The RN is responsible for initiating and ensuring execution of care plans for patients upon receiving physician orders for home health care. This is accomplished by managing the utilization of nursing, therapy, social services, and home health aides, and coordinating and informing all pertinent patient care information to other providers in the community that provide care to the patient. The RN Case Manager provides leadership and direction to nurses, therapists, social workers, and home health aides caring for patients under your direct management.
JOB DUTIES AND RESPONSIBILITIES
- Responsible for overall care, treatment, and company assigned outcomes for patients assigned to you. Providing transitional care, initial evaluation, case management, care coordination, and follow-up care for patients assigned to you under the treatment plan ordered by the physician. (EF)
- Acts as Alternate Agency Disaster Coordinator in the absence of the Director or Alternate Director. (EF)
- Delegates duties to aides and LVNS. Supervises aides and LVNs. (EF)
- Performing transitional care which includes communicating with facilities prior to a patient going home. Performing a transitional care visit(s) to ensure proper coordination from facility to home. (EF)
- Performing comprehensive assessments of patients at admission, transfer, discharge, and recertification by providing evaluations and accurately assessing and answering OASIS questions. Documentation must be in compliance with the Episode Management Flow Chart and regulatory requirements. (EF)
- Performing care coordination. This includes coordinating care amongst all providers for the patient through phone calls, faxes, etc. Ensuring proper coordination to patients assigned to you. (EF)
- Keeping amount of re-hospitalized patients assigned within 30 days to a minimum through the use of transitional care, case management, care coordination, and direct clinical visits. (EF)
- Ability to show improvement in functional scores for patients through OASIS documentation. This is achieved by utilizing home health disciplines correctly and all clinicians working in unison to meet the goals of the patient. (EF)
- Performing follow-up skilled nurse visits to meet the goals that are set forth for the patient. (EF)
- Scheduling patient visits efficiently. (EF)
- Participate in the On-Call rotation. (EF)
- Meeting weekly for case conference and providing insight into patient care. (EF)
- QA all clinical documentation for patients assigned to you. (EF)
- Coordinate with PT, OT, and/or ST to ensure the patient's therapy needs are met and therapy is appropriately provided. (EF)
- Provide infection and occurrence reports when needed. (EF)
- Update and ensure patient medication profiles are accurate. (EF)
- Assists with clinical record reviews. (EF)
- Participates in the PI program. (EF)
- Accompany patient to physician appointment when appropriate. (EF)
- Make DME referrals when appropriate. (EF)
- Assist the Supervising Nurse/Alternate Supervising Nurse when needed. (EF)
- Complies with all Home Health State and Federal Regulations (EF)
Hospital:
1. Adheres to organization-wide and other applicable policies and procedures.
2. Day-to-day performance complies with the hospital's Service Excellence Behavioral Expectations.
3. Performs within the prescribed limits of the hospital's Ethics, Compliance and Confidentiality Program guidelines.
4. Performs within his/her professional Scope of Practice at all times.
Other Duties As Assigned:
- Nothing in this job description restricts management's right to assign or reassign duties and responsibilities to this job at any time.
EDUCATIONAL REQUIREMENTS
Required: Graduate of an accredited college, university, or school of nursing
EXPERIENCE
Required: 6 months in a hospital setting
Preferred: 1 year in a hospital setting. Previous home health experience.
SPECIAL SKILLS AND ABILITIES
Required: Computer skills, communication skills, ability to perform well in stressful situations
Preferred: Wound care skills, central line skills
LICENSURE / CERTIFICATION REQUIREMENTS
Required: Current License Registered Nurse by the Texas Board of Nursing, Driver's License, and CPR certification required.
COMPANY PROFILE
Citizens Medical Center is a not-for-profit, community hospital known for compassionate patient care, clinical expertise, and bringing advanced medical services to the South Texas region since 1956. Today, Citizens is a 317-bed acute care hospital with over 1,200 employees. Voted "Best of the Best" hospital in Victoria for 14 consecutive years, Citizens Medical Center is a level III Trauma Center, with a newly renovated 24/7 Emergency Department that includes an onsite medical helicopter. Citizens has a comprehensive Community Cancer Program that includes two linear accelerators and HDR brachytherapy. Citizens is recognized for its outstanding cardiology program which includes a nationally accredited Chest Pain Center and is a Primary Stroke Center. Citizens also includes a comprehensive, accredited Bariatric Surgery program, Birth Center with labor and delivery, an imaging and surgery center, sleep study center, state-of-the-art rehabilitation and fitness center, urology center and daVinci robotics minimally invasive surgery options, a home health agency, and has a long history of providing continuing education for healthcare providers and the community.
Citizens Medical Center is looking for employees who actively demonstrate service excellence by exemplifying our iCare values. If you are someone who displays respect and enthusiasm for patients, visitors, and coworkers while consistently upholding the hospital's commitment to providing outstanding outcomes, service excellence, and fiscal responsibility, then you could be a good fit for the CMC team
BENEFIT OFFERINGS
Health
- Medical, Dental, Vision
- STD, LTD Disability
- Supplemental Life, AD&D
- Flexible Spending (FSA)
- Employer paid life insurance and short term disability
- Defined Benefit Pension Plan
- 457(b) Deferred Compensation
- Paid Time Off
- Sick leave, Bereavement leave, Jury Duty/Witness Service
- Tuition Reimbursement
- Hospital-paid & administered annual immunizations
- HealthPlex (gym) membership discount
- YMCA partnership discount for childcare
- Employee Assistance Programs
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