Job Description Type of Opportunity: Full Time FTE: 1.000000 Exempt: No Work Schedule: Days
Summary:Responsible for case management of Home Healthcare patients. Ensures that care delivery is within quality and utilization guidelines and is directed toward the achievement of desired clinical outcomes for the disease state. Responsible for development, coordination and scheduling delivery of care through a multidisciplinary team to the patient in the home or community setting. The Case Manager assures completeness, timeliness and appropriateness of the patient care plan, its implementation and ongoing evaluation. Assures communication with the multidisciplinary team, support services and community resources to ensure that care goals are achieved in the most efficient and cost effective manner possible. Ensures that documentation is timely, accurate, complete and reimbursable. Is a patient advocate. Precepts newly hired nurses.Responsibilities
*Demonstrates nursing care management of patients as evidence by a. Assessments that are complete, timely, and appropriate of physical, mental, psychological/social (behavioral), functional, financial, treatment, resource and spiritual needs of patients.b. Analysis that defines problems that are capable of correction through home healthcare and hospice interventions and are prioritized in development of care plan.c. Intervenes consistently with orders and changes interventions with orders to meet changes in patient needd. Evaluates each visit the effectiveness of interventions and the patients response to intervention.*Provide direct patient care by assessing patient for care needs, resources to meet needs and developing a home care or hospice plan of care in conjunction with physician. Assures completion of required OASIS assessments according to regulations for home care and QAPI measures for hospice .*Coordinates implementation of the plan of care through a multidisciplinary home care or hospice team, community resources and the physician*Ensures plan of care is followed and that documentation complies with regulation.*Maintains a department productivity standard for visits and caseload management.*Demonstrates professional accountability for self-scheduling patient case load with appropriate frequency and duration, and concurrently updates schedule throughout the day as needed so that ongoing patient needs can be met.*Assure patients on case load are notified timely of their visits and of any unplanned schedule changes accommodating, when possible, patent preferences for time of day. *Precepts newly hired nurses, and students and serves as a resource person and professional role model as needed.*Maintain communication with the multidisciplinary team s and assures that orders for necessary care plan changes are obtained and assures that changes are communicated timely to the team. *Initiates documentation in the home and completely records all care delivery so that receiving staff have record of care delivered by the end of each day which includes admissions.*Demonstrates proficiency and competency in interventions (treatments) required through day to day practice and annual competency testing.*Delegate or assign aspects of patient care to health care team members commensurate with their validated competency to perform the task.*Be professionally responsible for current nursing research, current nursing standards, home care or hospice philosophy in order to maintain quality.*Be responsible for clinical supervision of licensed and non-licensed assistive personnel.*Participates in agency continuous quality improvement activities as required.*Assume other leadership roles as required by the department.*Responsible for weekend and holiday coverage and evening call for agency and patient home visits as required on a rotating basis.*Assure clinical outcomes are met and sustained .*Performs other functions as required.
Other information:*Minimum one year acute care experience within the last 3 years required and hospice or home care experience preferred.. Basic typing competency Need to have current drivers license as well as auto insurance. Education:Associate Degree Credentials:Registered Nurse-NMBenefits
Benefits Benefits are effective day-one (for .45 FTE and above) and include:
- Competitive salaries
- Full medical, dental and vision insurance
- Flexible spending accounts (FSAs)
- Free wellness programs
- Paid time off (PTO)
- Retirement plans, including matching employer contributions
- Continuing education and career development opportunities
- Life insurance and short/long term disability programs
About Us Presbyterian Healthcare Services is a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, it is the state's largest private employer with approximately 11,000 employees.
Presbyterian's story is really the story of the remarkable people who have chosen to work here. Starting with Reverend Cooper who began our journey in 1908, the hard work of thousands of physicians, employees, board members, and other volunteers brought Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system, serving more than 700,000 New Mexicans. We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come. About New Mexico New Mexico's unique blend of Spanish, Mexican and Native American influences contribute to a culturally rich lifestyle. Add in Albuquerque's International Balloon Fiesta, Los Alamos' nuclear scientists, Roswell's visitors from outer space, and Santa Fe's artists, and you get an eclectic mix of people, places and experiences that make this state great. Cities in New Mexico are continually ranked among the nation's best places to work and live by Forbes magazine, Kiplinger's Personal Finance, and other corporate and government relocation managers like Worldwide ERC. New Mexico offers endless recreational opportunities to explore, and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west. AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.