Case Management, Certified Case Manager (CCM), Discharge Plans, Disease Prevention and Control, Health Plan, Healthcare, Home Care, Medications, Nursing, Patient Assessment, Patient Care, Patient Education, Problem Solving Skills, Quality of Care, Registered Nurse (RN), Time Management, Treatment Plan
We are seeking an experienced Registered Nurse (RN) Case Manager to join our Home Health team. In this role, you will provide comprehensive patient assessments, develop individualized care plans, coordinate services across disciplines, and deliver skilled nursing care in patients' homes. The RN Case Manager serves as a key member of the interdisciplinary care team, ensuring high-quality, patient-centered care that promotes health, independence, and quality of life.
Key Responsibilities
- Conduct comprehensive patient assessments, evaluations, and re-evaluations.
- Develop and implement individualized care plans in collaboration with physicians, patients, families, and caregivers.
- Coordinate patient care through interdisciplinary communication and case conferences.
- Monitor patient progress and modify care plans as needed.
- Communicate significant changes in patient condition to physicians and healthcare team members.
- Document assessments, treatment plans, goals, interventions, and outcomes accurately and timely.
- Provide skilled nursing care in accordance with physician orders and agency policies.
- Educate patients and caregivers on disease management, medications, treatments, diet, and self-care techniques.
- Ensure continuity of care and coordinate discharge planning when appropriate.
- Advocate for patients and support their physical, emotional, and healthcare needs.
Ideal Candidate
- Compassionate and patient-focused nursing professional.
- Strong critical thinking and problem-solving skills.
- Comfortable working autonomously in community-based settings.
- Dedicated to delivering exceptional home health care and improving patient outcomes.