Home Health RN Case Manager - South Metro

Performs comprehensive medication assessments which may include but is not limited to reconciling medications in the home to the prescriber's list and the patient's diagnoses; monitoring the medications for effectiveness, side effects or adverse effects, and interactions; assessing the ability of the patient and the caregiver to safely and consistently administer the medications; and identifying any barriers or issues related to medication adherence. Performs comprehensive functional assessments which may include but is not limited to determine the patient's risk for falls and ability to safely perform activities of daily living (ADLs) and independent activities of daily living (IADLs), including the ability of the patient and caregiver9s) to safely manage all medical/assistive devices and equipment.

JOB SUMMARY

The registered nurse plans, organizes and directs/coordinates home care services and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individuals and families within their homes and communities.

DUTIES & RESPONSIBILITIES

• Complies with accepted ethical conduct and Professional Standards of Nursing Practice as set forth by the American Nurses Association and the "Nurse Practice Act" of the State of Colorado.
• Practices and maintains patient safety and dignity by abiding by Federal, State, Local and (insert company name) policy & procedures as pertains to patient protected health information and HIPAA (Health Information Portability and Accountability Act).
• Assess the physical, psychosocial, and environmental factors that affect a patient's health. In addition, they perform in-depth functional assessments and medication assessment.
• Performs physical assessments which may include but is not limited to interviewing patients and their caregivers about the patient's health history and diagnoses, and includes performing a complete physical assessment of all the patient's body systems and capabilities, along with a review of nutritional needs.
• Performs a psychosocial assessments which may include but is not limited to assessing the patient's cognitive, developmental, behavioral, and coping status and includes screening for anxiety, depression, and abuse or neglect. Furthermore, a psychosocial assessment discovers the patient's language preference, health literacy, learning style, and cultural needs and preferences. Special attention is paid to the multiple impacts the patient's illness and disease have on the family, the caregiver, and the patient's/family's finances.
• Performs environmental assessments which may include but is not limited to focusing on risks within the home and community to the patient's and home health clinician's personal health and safety. A home environmental assessment includes attention to obstacles within the home that may increase the risk for falls, presence of needed safety features, presence of smoke alarms, and safety practices that are required for home treatments, such as oxygen safety. Sanitation issues that may affect the risk of infection are also assessed.
• Performs comprehensive medication assessments which may include but is not limited to reconciling medications in the home to the prescriber's list and the patient's diagnoses; monitoring the medications for effectiveness, side effects or adverse effects, and interactions; assessing the ability of the patient and the caregiver to safely and consistently administer the medications; and identifying any barriers or issues related to medication adherence.
• Performs comprehensive functional assessments which may include but is not limited to determine the patient's risk for falls and ability to safely perform activities of daily living (ADLs) and independent activities of daily living (IADLs), including the ability of the patient and caregiver9s) to safely manage all medical/assistive devices and equipment.
• Assesses client's condition and needs, through the collection of health data, the recognition, interpretation and reporting of symptoms and psychological responses and re-evaluates the client nursing needs as required.
• Document diagnoses and identify problems from the assessment data.
• Partners with the patient, family, and other caregivers to identify specific, measurable, attainable, relevant, and time-defined (SMART) goals for the patient based on the patient's identified problems and diagnoses.
• Develops a plan of care in collaboration with the patient, family and other caregivers, and other healthcare providers.
• When the need for other services and supplies is identified, the home health nurse collaborates with the inter-professional home health team to further develop the most effective and economical plan.
• Develops and implements nursing plan of care with consideration for the dignity and desires of the client care, organizes and participates in direct client care, performs treatment and administers medications.
• Implements the plan of care and provides skilled nursing interventions to patients, as well as patients' families and caregivers, including direct care, teaching, counseling, coaching