RN Case Manager - Registered Nurse

Job Description Summary

Signature Healthcare at Home - Home Health is seeking a compassionate and experienced (preferred) RN case manager for the East side of Portland/PDX area. The Registered Nurse plans, organizes and directs home health care 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.

Pay: $56+ depending on experience.

Essential Job Functions/Responsibilities

Patient Care

Completes an initial, comprehensive and ongoing comprehensive assessment of patient and family/caregiver living situation to determine care needs. Provides a complete physical assessment and history of current and previous illness(es).

Provides professional nursing care by utilizing all elements of nursing process and as defined in the state Nurse Practice Act.

Assesses and evaluates patient’s status by: Establishing the initial individualized plan of care in collaboration with the certifying medical provider based on comprehensive assessment and patient goals. Regularly re-evaluating patient and family/caregiver needs. Participating in revising the plan of care as necessary in collaboration with the certifying medical provider as patient status and needs change.

Develops a care plan that establishes interventions and goals. Includes the patient and the family/caregiver in the planning process.

Works autonomously to initiate appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the medical provider in the plan of care.

• Involves the patient and family/caregiver to address needs and meet related goals.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Facilitates the patient’s efforts toward self-sufficiency or obtaining appropriate caregiving.

Acts as Case Manager when assigned by Clinical Manager and assumes responsibility to coordinate patient care for assigned caseload.

Communication

Documents patient services and status timely and accurately within professional practice standards and reimbursement requirements.

Records pain/symptom management changes/outcomes as appropriate.

Communicates with the medical provider regarding the patient’s needs and reports changes in the patient’s condition; obtains/receives medical provider orders as required.

Teaches the patient and family/caregiver self-care techniques as appropriate. Provides medication, diet and other instructions as ordered by the medical provider and recognizes and utilizes opportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary team.

Assists the patient and family/caregiver and other team members in providing continuity of care.

Attends required staff meetings, interdisciplinary team meetings and care coordination activities.

Additional Duties

• Participates in on-call duties as defined by the on-call policy.
• Ensures that arrangements for equipment and other necessary items and services are available.
• Supervises ancillary personnel and delegates responsibilities when required.
• Coordinates patient care in tandem with LPN/LVN as assigned by Clinical Manager.
• Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in-service classes.
• Fulfills the obligation of requested and/or accepted case assignments.

Actively participates in quality assessment performance improvement teams and activities or other committees as assigned.

May be required to work outside of designated geographical area based on census fluctuations and current staffing.

• Completes mandatory education requirements annually to maintain competence.
• May be required to visit patients in homes that are not clean, or in poor repair, have poor ventilation, are infested with insects or rodents, and secondhand smoke.
• Driving conditions may be difficult related to weather and/ or traffic.
• Maintains knowledge of and adheres to all applicable laws, rules, and standards.
• Participates in the orientation of new employees and preceptorship of students as assigned.
• Meets productivity expectations.

The above statements are intended to be a representative summary of the major duties and responsibilities performed by incumbents of this job. The incumbents may be requested to perform job-related tasks other than those stated in this description.

Position Qualifications

Graduate of an accredited school of nursing. One (1) to two (2) years of recent acute care experience in an institutional setting, and one (1) to two (2) years of recent experience in home health preferred.

• Currently licensed as a Registered Nurse in the State(s) of planned practice.
• Possesses and maintains CPR certification.

Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and is in good working order.

Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist.

Self-directed and able to work with minimal supervision.

Capable of prolonged or considerable walking or standing. Able to lift, position and/or transfer patients. Able to lift supplies and equipment. Capable of considerable reaching, stooping bending, kneeling, and/or crouching. Possesses visual acuity and hearing to perform required nursing skills.

The employer for this position is stated in the job posting. The Pennant Group, Inc. is a holding company of independent operating subsidiaries that provide healthcare services through home health and hospice agencies and senior living communities located throughout the US.

Each of these businesses is operated by a separate, independent operating subsidiary that has its own management, employees and assets. More information about The Pennant Group, Inc. is available at pennantgroup.com.