GENERAL INFORMATION:

Position Title: Registered Nurse Case Manager

Pay Status: Staff, Non-exempt

RESPONSIBILITIES:

• Assumes responsibility and accountability for the practice of professional nursing in the manner consistent with the Indiana State Nurse Practice Act, and the American Nurses Association Standards for Home Health Nursing.
  1. Performs comprehensive subjective and objective admission and ongoing assessment as outlined with the federally mandated OASIS Assessment forms
  2. Formulates individualized plans of care, which incorporate analysis of assessment data and current scientific findings
  3. Provides skilled interventions aimed at achieving the patient’s needs and within the context of his/her and legal scope of practice
  4. Modifies and updates the plan of care to reflect progress toward outcomes
• Authorized to accept verbal orders from the physician and document in the patient’s clinical record
• Consistently demonstrates competency with technical nursing skills according to personal and legal scope of practice
• Implements teaching appropriate to the patient’s needs and within the context of his/her environment and value system
  1. Assesses knowledge level and identifies learning needs
  2. Plans, teaches, supervises and counsels regarding physical care, measures to promote improvement/recovery, symptom/complication management, expected disease progression, social/emotional care, and community resources
• Practices nursing with respect for individual, cultural and spiritual differences
• Coordinates delivery of care along health care continuum utilizing community resources, discharge planning and case management
  1. Integrates knowledge of funding issues into plan of care
  2. Anticipates needs depending on changing patient/family status
  3. Utilizes supplies, medications, equipment and personnel in a responsible and cost-effective manner to achieve desired outcomes
  4. Negotiates and collaborates with other health care providers to achieve expected outcomes of patient care
  5. Assists and advocates for patient access to resources according to prioritized needs
  6. Assumes responsibility for safe patient care for assigned caseload
• Communicates effectively and in accordance with agency requirements
  1. Relays significant changes in status to physician and other members of the staff in a time period consistent with patient needs
  2. Maintains patient records showing systematic assessment, planning, intervention and evaluation
• Demonstrates teamwork and effective communication to accomplish patient, team, and agency goals
  1. Attends and actively contributes to interdisciplinary team or other required meetings
  2. Shares areas of specialized expertise among and between teams, initiating appropriate interdisciplinary referrals
  3. Integrates agency values into nursing practice and working relationships
• May be called upon to perform additional tasks as assigned by the Director of Nursing

WORKING ENVIRONMENT:

60% of work within office, 40% in field when needed

JOB RELATIONSHIPS:

Supervised by: Director of Nursing

RISK EXPOSURE:

Low risk

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

• Participate in physical activity
• Work for extended period of time while sitting, standing and/or being involved in physical activity
• Moderate lifting
• Moderate bending, lifting and standing on a regular basis