Nurse Care Coordinator

3 weeks ago

Hauppauge, New York, United States Ideal Home Care, Inc Full time
Job Title: Registered Field Nurse

Job Summary:

The Registered Field Nurse is a key member of our team, responsible for delivering high-quality patient care services through coordination, implementation, and supervision of field staff. This role requires strong leadership and communication skills, with a focus on ensuring that field staff follows the Plan of Care (POC) and delivers care accordingly.

Responsibilities:

  • Lead and direct members of the patient care team through case management of patient home health episodes of care.
  • Conduct initial in-home evaluations and assessments to establish patients' individualized treatment and medical record baselines.
  • Collaborate with physicians, other agency staff, and contract services to coordinate and implement the POC.
  • Supervise the implementation of the POC and the quality of care delivered to patients.
  • Provide in-home supervision of field staff at least every 90 to 180 days for patients receiving aid services and document the visit in the medical record (EHR).
  • Implement and evaluate nursing care and patients' plans of care.
  • Re-evaluate the patient plan of care at least every 90 to 180 days and revise as needed.
  • Develop policy and procedures when appropriate.
  • Conduct new employee orientation and in-services.
  • Supports DPS and assumes his/her duties during her absence.
  • Document direct patient services, coordinate and collaborate with physicians and other disciplines, which provide care services to the patient.
  • Ensure documents are completed and comply with home health standards and Agency policy.
  • Facilitate active and effective communication with team members.
  • Manage patient case conferences, staff education or in-services, and timely clinical decisions which provide guidance in the delivery of patient care.
  • Document clients' health charts in a timely manner and meet professional standards of practice.
  • Ensure compliance with state regulations and Medicaid conditions of participation.
  • Reviews caseload and charts documents to ensure compliance and assess patient progress and effectiveness to meet patient goals.
  • Schedule staff according to client needs when needed.
  • Monitor aides' compliance according to agency policy and procedure and DOH guidelines.
  • Ensures that MD orders are faxed timely, follow with MD offices to ensure timely receipt.
  • Generates and monitors various reports from the management system to ensure quality care.
  • Provides patients and staff supervision when assigned on-call.
  • Collaborating with leadership/management team and office staff to facilitate timely office processing of paperwork and personnel information.
  • Actively participates in Agency quality improvement activities.
  • Promote the Agency and services to the public and participate in physician and community education related to services provided by the agency as registered.

Qualifications:

  • Must be a Registered Nurse with a public health, home health care, or hospital background.
  • Must have at least 2 years of clinical experience.
  • Must be able to communicate clearly and effectively.
  • Must be able to travel to clients' residences when required.
  • Must be able to stoop and bend; to be able to lift and transfer clients.

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