Position Summary

Provides skilled nursing care in accordance with the client's plan of treatment, including comprehensive health and psychosocial evaluation, monitoring of services, teaching and training activities and provision of direct nursing care.

Key Responsibilities

• Responsible for continuous review of all aspects of every patient on his/her caseload to include: appropriate utilization of services; ensuring continued skilled need; monitoring of homebound status; review of documentation in the medical record; maintenance of interdisciplinary communication and discharge planning.
• Completes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illness (es). Admits to appropriate level of service/ care.
• Uses health assessment data to determine nursing diagnosis.
• Initiates the plan of care and makes necessary revisions as patient status and needs change.
• Develops a care plan, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions. Includes the patient and the family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Provides supervision of LPN’s and home health aides per standard and regulatory requirements.
• Responsible to reassess the patient within 24 hours following a change in condition or discharge from an inpatient setting. Case manager should be the first RN to visit the patient status post hospitalization; updates the plan of care.
• Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient.
• Knowledge of state, federal, and local regulations for the delivery of home health services.

Communication

• Prepares clinical notes and updates the primary physician when necessary and at least every sixty days.
• Communicates with the physician regarding the patient’s needs and reports and changes in the patient’s condition; obtains/receives physician’s orders as required.
• Communicates on a regular basis with the team and the area team leader.
• Communicates with community health related persons to coordinate the care plan.
• Teaches the patient and family/ caregiver self-care techniques as appropriate provides medication, diet and other instructions as ordered by the physician. Recognizes and utilizes opportunities for health counseling with patients and families/ caregivers.
• Provides and maintains a safe environment for the patient.
• Assists the patient and family/ caregiver and other team members in providing continuity of care.

Position Qualifications

• Graduate of an accredited school of nursing. Associates or Bachelor’s degree, with one year of home health care experience
• Current licensure in State, CPR certification and valid driver’s license.
• At least one year of recent experience working as a professional nurse in an acute care setting

Job Types: Part-time, Travel nursing, PRN

Medical specialties:

• Home Health

Weekly schedule:

• Monday to Friday
• Weekends as needed

Experience:

• Home health: 1 year (Required)

License/Certification:

• RN (Preferred)

Work Location: Multiple locations