Objective:
The Nurse Case Manager position will provide professional services and care to seniors through an interdisciplinary approach. Our independently owned and operated Home Instead franchise business is looking to expand our scope capabilities through consultation, assessment, planning, and evaluation by supporting the best possible outcomes for our seniors/clients. This position will have knowledge on case management theory with a consultative approach for our clients/families. The ideal candidate will have knowledge of payor sources such as long-term care insurance, Medicaid and Medicare Advantage as well as other federal, state/provincial, and local regulations. The Nurse Case Manager position will manage and lead our team of Care Professionals through training and nurse delegation to assure the highest standard of quality care and safety is given to our clients.
Primary Responsibilities:

• Establish working knowledge of all business policies and procedures, including those governing delegation, supervision, and training and ability to reference them from appropriate sources.
• Assess the patient; collect and document the patient's current health status and medical history. Complete and/or review client data as defined by policy and procedure. Make accurate and ongoing assessment of client's status and respond appropriately.
• Set priorities for nursing action in logical sequence according to client's needs and plan of care.
• Create a client plan of care, after the initial assessment and evaluation visit with clients, and coordination with other providers for the client, to meet client needs. Review the plan of care as often as the severity of the client's condition requires, at minimum every 60 days or more frequently if required by state rules.
• Update the plan of care based on all aspects ongoing assessments.
• Determine where delegation of nursing services is appropriate in accordance with applicable regulations, individual client condition, and each assigned team member's training and demonstrated competency, and maintain documentation of all factors evaluated in making the determination(s).
• Based on ongoing assessment of client status, accurately and completely document care to reflect nursing interventions, client responses to care provided, client needs, problems, capabilities, limitations and progress toward goals.
• Communicate with the entire healthcare team (internal & external) to eliminate barriers to efficient delivery of care assessment. Documentation of medical orders is handled promptly as required by policy and procedure.
• Available for remote and regular on-site supervision of the provision of services by Care Professionals as needed to ensure quality of care, client safety, and meet state standards.
• Administer clinical services within Home Instead scope, that require a professional license in conjunction with our policies and procedures. Observe, report and document the client's response to the above.
• Determine the ability and appropriate technical skills when administering treatments and procedures in accordance with physician's orders and policy and procedure.
• Demonstrate ability to handle emergency situations in a prompt, precise and professional manner.
• Exhibit ability to respond to changing situations in a flexible manner to meet current needs, such as reprioritizing work as necessary. Organize job functions and work area to be able to effectively complete varied assignments within established time frames.
• Give thorough, concise reports to Care Professionals about client's needs, which communicate pertinent information in a timely manner.
• Demonstrate working knowledge and implementation of infection control practices.
• Supervises the provision of services provided by the Care Professionals and provides feedback on performance as indicated.
• Must possess a valid driver's license or state identification.
• Must possess valid auto insurance (if applicable)

Minimum Qualifications:

• A graduate from an accredited school of nursing, with a nursing degree is required. Prior home health and nurse delegation experience is desired. Must maintain a current license in good standing as a registered nurse in the state or hold a compact state license accepted by the state
• Knowledgeable of client legal rights, always respects client rights, and reports the failure of any other person to comply with patient rights including abuse, neglect, or disrespect.
• Maintains confidentiality regarding all patient's personal, financial, and health information including following HIPAA guidelines.
• Knowledge of case management/Managed Care theory and nursing assessment practices related to home care.
• Coordinates/facilitates client care throughout the care continuum.
• Strong interpersonal, communication and people skills to be able to write reports and speak in front of several individuals and communicate clearly.
• Be knowledgeable in regulation of long-term care payers and providers.
• Ability to assess the client's mental status, monitor, record and develop individual treatment plans and goals.
• Ability to gather data, prepare and compile reports to ensure appropriate services and client's activity tracking in relation to care plan.
• Be able to provide emergency services and make immediate clinical assessment and coordinate with other services.