- Direct Placement
- Home Care
- Downey, CA
SUMMARY: The RN Case Manager is the member of the interdisciplinary team who is the pivotal person in identifying the physical, psychological, social and spiritual needs of the patient and family. The RN Case Manager initiates appropriate intervention and support for the patient and family upon admission and provides a continuously appropriate, comprehensive and responsive plan of care.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned.
- Case Management and Supervision
- Coordinates the patient's and families care and services including those of the team, social worker, chaplain, home health aide, volunteer and physician.
- Responds necessary information to the senior case manager.
- Monitors the re-certification / re-authorization process.
- Participates in Interdisciplinary Team Meetings as indicated.
- Ensures and documents appropriate use of the medications, durable medical equipment and supplies.
- Educates patients, families and other caregivers.
- Provides skilled nursing as determined by the interdisciplinary plan of care.
- Appropriately utilizes the skills and resources of contract personnel such as PT, OT, Dietary, Speech and Pharmacy.
- Provides appropriate care plan and integrates care plans as needed.
- Performs on site evaluations of HHAs and volunteers.
- Participates in the on-call rotation and weekends.
- Quality Improvement
- Integrates QI results into the established plan of care.
- Participates in QI assessment routinely.
- Participates in proactive patient calls.
- Participates in routine chart reviews.
- Clear and Active California RN License
- Reliable transportation with adequate insurance coverage for driver and passengers
- Clear background and driving record
- Three years Hospice Nurse experience; field case management