RN Case Manager

  • Registered nurse currently licensed in Ohio
  • Minimum one year experience in health care
  • Experience as a supervisor or in quality assurance in health care
  • Good physical and psychological health 
  • Dependability and reliability with knowledge that client needs care first
  • Heartfelt desire to "make a difference" in life and for all people he/she comes into contact with.
  • Excellent organizational skills with keen attention to detail
  • Highly focused on client service and ability to deal with a diverse population groups
  • Excellent at education, leading and being an inspiration to other interdisciplinary health care members.
  • Professional demeanor, affect and look.
  • Should possess sound technological knowledge with ability to function in a number of computer systems.
  • Independent and self-directed yet able to function as a team member
  • Reliable transportation and ability to travel to client homes, getting in and out of the car during all types of conditions. 
  • Ability to triage clients with telephone data and make sound judgments with appropriate interventions.
  • Ability to handle a variety of sensitive inquires, client/family concerns, with professionalism. 
  • Ability to lead, manage and present to subordinate staff, family members, clients and office personnel. 
  • Must be optimistic, passes a "can do attitude" and be willing to roll your sleeves up to get the job done. 
Basic Role 
The RN Case Manager is responsible for identifying and coordination client needs and for providing preventative, supportive, supervisory and educational care to assigned clients. The case manager utilizes assessment, intervention and education to maximize delivery of care and to enhance the quality of life for all clients.
Organizational Relationship
  • Responsible to: Assistant Director of Nursing and Director of Nursing
  • Employees Supervised: LPN, RN, Home Health Aide, Home maker, Therapist
  • General responsibilities
- Demonstrates a clear understanding of the mission, vision and value statements of organization.
- Adheres to ethical practices by striving to perform in a manner that conforms to the highest standards of ethical behavior, integrity and honesty.
- Takes initiative and responsibility for decision and behavior. Exhibits commitment, professional growth and goal obtainment. 
- Participates in the ongoing development of competencies, capabilities, technology and the resources needed to achieve high standards of efficiency and effectiveness. Approaches everything with the passion and desire to meet the highest standards. 
- Places needs of the client first at all times. Care management and service delivery are developed with the goals of the clients healing and support in mind
- Strives to deliver lasting value to our clients in their home. 
- Strives to help lead home health care through vision, technology, innovation, and customer service. Strives to make a difference in the lives of our employees, clients and community. Encourages a positive environment and experience for co-workers and clients.
- Treats employees, clients, and business partners with respect. Fosters teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization. Embraces diversity and demonstrates the ability to work together. 
- Promotes a safe and efficient working environment by adhering to agency policies and procedures.
- Maintains confidentially of all agency and client related information. Protects patient rights as defined in the patient Bill of Rights.
- Maintains proper attendance and punctuality to ensure that the department is operated in an efficient and cost effective manner.
- Adheres to department and agency dress code as observed by supervisor.
- Communicates information effectively both verbally and in writing.
- Attends and participates in staff meetings, required in-services, agency PI activities and other meetings as requested.
- Utilizes material, equipment and time in a safe, beneficial, and cost effective manner.
- Organizes workload to complete responsibilities in an appropriate and timely manner.
- Observe infection control and standard precautions. 
  • Client care
- Completes initial assessment and comprehensive assessment of client, family and environment to certain needs. Provides for complete client medical physical assessment, and strong history.
- Provides professional nursing care utilizing all components of the nursing process.
- Assess, evaluate, recertifying or discharge client by: 
  1. Development of skilled or unskilled plan of care
  2. Routine reevaluation of client needs, updating and revising plan of care and appropriately documenting need.
- Initiates the plan of care to ensure clients needs are being met. Provides for reevaluation/recertification of clients needs and adapts plans routinely, develops client goals and discharge plans. 
- Utilizes assessment information for determination of nursing diagnosis and client care goals.
- Includes client and primary caregivers in care planning process. 
- Develops a plan of care that establishes goals incorporating education and palliative care into treatment plan. 
- Administers medications and treatments as prescribed by the physician orders.
- Educates, counsels and informs family/client on matters that interfere with the delivery of care. 
- Provides health care education to client per needs assessed
- Facilitates clients behavior towards maximum self sufficiency and optional quality of life
- Functions as coordinator of client care with all interdisciplinary healthcare members. 
- Ensures that arrangements for equipment and necessary items/services are available.
- Supervises all interdisciplinary health care members on assigned cases.
- Takes initiative to maintain and upgrade professional knowledge and skills through attendance and participation in continuing education classes.
- Actively incorporates quality improvement plans, suggestions, information into the delivery of care. 
- Completes, maintains and submit accurate, concise and relevant clinical notes regarding client coordination and delivery of care. Records reflect pain management, education, coordination of care activities, and changes in client states/condition.
- Communicates openly, honestly and professionally with clients physician and reports changes in states/condition. Obtains necessary orders for appropriate intervention.
- Communicates with country or state case managers, insurance case managers or payor sources giving updates and making adaptions to the plan of care. Assists client in coordinating physician appointments and updates. 
- Educates client, family and other care givers self care techniques. provides education on medication, diet, exercises, disease processes/diagnosis, age appropriate changes, preventative care, safety, equipment usage, emergency preparedness, pain management, and fall risks.
- Monitors client home conditions making assessments and recommendations to ensure that client and employees are safe.
- Spends time focusing on client care with holistic approach coordinating physical, psychological and social needs.
- Primary focus will be on client with advocacy at the top of the list of priorities. 
- Assists in emergency situations helping to coordinate with the director of nursing emergency preparedness response systems. 
- Monitors visit frequency and duration, and review physician orders to monitor compliance. 
- Reviews results of laboratory tests and other diagnostic procedures. 
- Assures responsibility for maintaining county, state and federal regulatory guidelines. 
- Alternates necessary level of care for client maintenance at home, prioritize visits and delivery of care on clients health assessment. 
- Assures on-call RN responsibility during necessary times for coverage of client care.
- Strives to be professional, business etiquette functioning as ambassador for home health care and organization. 
- Leads employees in home health care with clear visions, beliefs and understanding that clients come first. case management and delivery of care are developed with goals of clients delivery of care, healing and peaceful mind at the forefront. 
- Participates in peer review process if deemed necessary.