Registered Nurse -Case Manager, Home Health, Full time, Daytona - Home Health
Company: Halifax Health Medical Center of Daytona Beach
Location: Daytona Beach
Posted on: January 20, 2023
Registered Nurse -Case Manager, Home Health, Full time,
* Initiates the Brooks Home Care experience by representing self as
the Brooks Home Care Case Manager to patient and family. The RN
Case Manager explains the clinical case manager role and process to
the patient and family should contact clinical case manager for all
coordination of home health services and needs.
* Provides initial assessment of the patient and the family for
appropriateness and acceptance of home health care services,
establishment and ongoing review of the plan of care,
implementation of medical treatment orders, referral, follow-up,
provision and supervision of nursing care, coordination of services
given by other health care providers, and documentation of all
activities and findings.
* Responsible for ensuring that all assessments and the plan of
care is up to date, reflect current status, and needs of the
patient throughout the care of the patient.
* Serves as a health care educator by teaching and training
patients and caregivers regarding the identified health care
* Enhances a collaborative relationship to maximize the patient's
and family's ability to make informed decisions, including the
patient and/or family's home health goals into the overall plan of
* Responsible for maintaining a concurrent medical record using
specific standards of practice and agency guidelines.
* Provides and coordinates skilled nursing care as outlined in the
nursing care plan to include pertinent signs and symptoms while
also reporting significant changes to the physician including
revisions to treatments, drugs, and changes in the patient's
physical and emotional condition.
* Evaluates every patient for additional home health services to
include skilled therapy (PT, OT, SLP, RT), HH Aide and other
* Refers cases where patients and/or family would benefit from
counseling and/or community resources required to enhance the
overall plan of care and meet the patients and caregivers needs for
appropriate discharge planning to social worker.
* Direct oversight and review of changes in the patient's condition
and/or family and home situation, makes revision in the plan of
care as needed, and notifying the physician of patient's condition
and progression at least every 60 days.
* Completes an updated OASIS when Significant Changes in Condition
* Communicates with physicians and other health care providers
throughout the home care treatment and develops an effective
* Supervises, evaluates, and verifies care given by home health
aide follows the plan of care as written. Updates the home health
aide Plan of Care as the needs of the patient changes and ensures
home health aide operates according to policy and regulations.
Supervisory visits conducted every 14 days.
* Supervises and evaluates the care given by the LPN every 30 days
or more frequently if necessary.
* Facilitates interdisciplinary patient care conferences to review
treatment goals, optimize resource utilization, provide family
education, and identified post-hospital needs.
* Promote effective and efficient utilization of clinical resources
and services from admission through discharge.
* Evaluate patient satisfaction and quality of care provided.
* Acts as patient advocate: investigates and reports adverse
occurrences, and performs staff education related to resource
utilization, discharge planning, and psychosocial aspects of
* Participates in clinical record reviews, staff meetings, and
in-services as needed.
* Serves as a mentor and preceptor for nurses and other home health
* Serves as the RN on-call Nurse as scheduled on a rotating
* Serves as the visiting Weekend RN Nurse as scheduled on a
* RN should be able to accept additional patients beyond their
normal work schedule as needed.
* Actively supports the established Brooks organizational values
(Innovation, Integrity, Teamwork, Service, Excellence, and
Accountability) as evidenced by behavior and job performance.
* Current licensed Registered Nurse in the state of Florida.
* Associate, Bachelors, or Master's degree from an approved school
* One-year recent nursing experience required.
* Prefer at least one-year's home health, Acute Care or adult
health nursing experience.
* Must be a licensed driver with an insured automobile in
accordance with requirements.
* TB skin test or chest X-ray as proof of freedom from TB every
* Current CPR certificate. Hands-on BLS certification.
* Maintains BLS certification and assumes responsibility for
maintaining required continuing education and unit specific
* Will consider sponsorship. Must have:
* 2 years' applicable experience
* Current Florida Nursing license or evidence of having passed
* English proficiency
Keywords: Halifax Health Medical Center of Daytona Beach, Daytona Beach , Registered Nurse -Case Manager, Home Health, Full time, Daytona - Home Health, Executive , Daytona Beach, Florida
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