RN - Case Manager - Home Care Kenosha (Full Time 1st shift)
Location: Racine, WI (53403), Kenosha, WI (53140)
Horizon Home Care and Hospice is seeking experienced nurses to join our top-notch Home Care team.
As a RN Case Manager you will coordinate and manage the intermittent services of a client through development, implementation and evaluation of a plan of care, working in collaboration with the interdisciplinary team and provide services at quality levels consistent with professional standards of practice.
- In collaboration with the patient/caregiver, completes patient plan of care and submits admission paperwork within 72 hours.
- Accurately and timely performs ongoing assessments of patients as evidenced by visit documentation, follows physician orders and plan of care revisions based on assessment findings.
- Identify patient goals and develop a plan and implement interventions.
- Ensure goals are clearly delineated and prioritized on the patient plan of care and addressed by all team members
- Case conferencing with team members occurs regularly which includes creating PCW/HHA Care Plans, initiating and updating Plans in accordance with patient needs and Agency policy.
- Plan of care is revised on a regular basis reflecting changes in patient's on going assessment and /or progress or lack of progress toward goals.
- Inform physician, clinical manager and interdisciplinary team members of changes in patient status as evidenced by Case Communication documentation.
- Audit all clinical records upon recertification and discharge to evaluate content and compliance with State/Federal regulations and Agency policy and procedure.
- Assure appropriate discharge planning occurs from the start of care by utilizing a multidisciplinary approach and appropriate documentation.
- Coordinate with Prior Authorization Nurse the patients need for continuing services and providing accurate assessment data to support ongoing service.
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