The Case Manager /Nurse Supervisor identifies and coordinates patient/family caregiver home care needs and provides supportive care to patients and their families in addition to supervising agency staff according to the patient specific plan of care. The Case Manager/Nurse Supervisor will primarily be engaged in exempt duties. Such duties will include performing office or non-manual work directly related to the management and general operations of the company and or the company's clients. The Case Manager/Nurse Supervisor will customarily and regularly exercise discretion and independent judgment with respect to matters of significance, will supervise others, and will perform work only under general supervision.
1. Completes a comprehensive assessment for newly admitted clients and when reassessment is indicated, minimally every 60 days.
2. Submits new admission documentation to the Clinical Manager within 48 hours.
3. Develops a plan of care, including teaching objectives and a schedule of services/visits in collaboration with the physician, patient/family caregiver and other members of the health care team.
4. Case manages patient care within the guidelines of the various payor sources.
5. Prepares patient/family caregiver for discharge when appropriate.
6. Implements observational and assessment skills: vital signs, physical exam, psycho/social status, environmental and safety factors. Assesses progress.
7. Makes referrals to appropriate services to provide comprehensive patient care.
8. Makes social and family welfare assessments and referrals when necessary.
9. Reports to the Clinical Manager and physician (when appropriate) changes in the patient's signs/symptoms, physical status or major changes in care plan or referral to other services.
10. Consistently completes all appropriate patient record documentation, making sure to include patient response to the plan of care.
11. Communicates to all members of the health care team to improve the quality and coordination of patient care.
12. Completes discharge documentation upon discontinuance of service/plan of care to include general course of care, condition on discharge and to whom discharged.
13. Delivers all documentation to the Clinical Manager's office by 12:00 noon every Monday and Thursday.
1. Selects caregivers for specific cases, assessing their skills and evaluating their competency once assigned through regular supervisory visits.
2. Teaches, instructs, and counsels each caregiver assigned to their caseload.
3. Removes caregivers from patient assignments if caregiver is for any reason
(unable/unwilling/unavailable/unskilled) to follow the plan of care.
4. Communicates with the Clinical Manager, and other members of the administrative team, observations related to supervisory activities, including but not limited to instruction, counseling, and caregiver changes in order to facilitate coordination of care.
MONTHLY CASE CONFERENCES:
1. A monthly case conference must be held, recorded, and filed on each
patient of the nurse's caseload.
2. The Clinical Manager must be apprised via verbal report on a weekly basis as to the nurse's caseload/patient status and will be involved in selecting patients for monthly case conferences.
1. Any changes in patient visit schedule must be reported immediately to the
2. The caseload shall be limited to thirty-five (35) patient visits per week to
ensure adequate and quality patient care.
3. This patient caseload can only be adjusted with a direct supervisory visit and approval by the Clinical Manager.
1. There shall be a planned and ongoing in-service program to improve
practice. Attendance is required.
1. Minimum of six (6) months recent work experience as a home care nurse within the past (5) five years. Must pass a skills validation test.
2. Current Nursing licensure in your state of employment.
3. Satisfactory references.
4. Satisfactory completion of Agency RN Qualifying Exam.
5. Current CPR certification.
6. Ability to compose effective written and oral communication with customer service focus.
7. Excellent phone etiquette is mandatory.
8. Ability to multi-task in a fast paced environment.
9. Strong organizational abilities required.
Regularly required to sit, to use hands to finger, handle, or feel, and talk or hear. Frequently required to reach with hands and arms. Occasionally required to stand, bend, and walk. Must be able to occasionally lift and/or move up to 10 pounds. Specific vision abilities required by this job include close, distance, and peripheral vision, depth perception and ability to adjust focus.