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Hexaquest Health is Hiring a RN - Case Manager - HH Near Antigo, WI
General SummaryThe Registered Nurse, Case Manager is a professional who assumes the responsibility and accountability for the provision of assessment, planning, implementation, coordination, monitoring and evaluation of nursing care options and services provided to Home Health patients of all ages and their families to meet the patients health needs through communication and available resources across the health care continuum in all settings. The Registered Nurse, Case Manager participates in the development of care plans in partnership with Home Health employees and volunteers, Aspirus, Inc. entities and community partners. Principal Duties And ResponsibilitiesPatient Experience "Identifies opportunities to improve patient experience. Participates in projects/programs designed to enhance service delivery and patient satisfaction. Job Specific Duties "Utilizes the nursing process through assessment, planning, implementation, and evaluation to assure needs of patients are identified and met through an interdisciplinary team approach. "Initiates Plan of Care in collaboration with patient/family, attending physician, and other interdisciplinary group members within 24 hours of admission. Updates plan of care of assigned patients as condition changes, minimally every 2 weeks. "Assumes primary responsibility for meeting and coordinating needs of patients in assigned caseload, setting appropriate frequencies as patient needs change. "Applies pain/symptom management best practices skills when caring for patients. Acts as patient advocate in interactions with physicians to obtain optimal orders for pain/symptom management. "Assures adequate supply of medications and medical supplies for each patient in a cost-effective manner. Follows Aspirus Home Health and Hospice guidelines in authorization of medications and supplies. "Communicates significant information about patients to attending physician, Home Health and Hospice Manager, and other interdisciplinary team members assigned to the patient in a timely manner. Recommends changes in level of care as appropriate. "Documents patient status, nursing care provided, teaching activities, and communication with interdisciplinary group and others, in prompt and complete manner using appropriate documentation practices. "Actively participates with interdisciplinary teams (nursing peers and therapy) by sharing information and ideas regarding patient care and symptom management. "Provides Home Health Aide supervision in the care of assigned patients. "Provides Licensed Practical Nurse supervision per agency policy. "Participates in on-call and sick/vacation coverage responsibilities, receiving and delivering report on patient status updates in a timely manner. "Makes referrals to community agencies in collaboration with Social Worker. Assessment/Reassessment "Performs intake assessment in a timely manner "Completes comprehensive nursing assessment in a timely manner "Convenes with interdisciplinary group to review intake assessment and establish initial plan of care within established time frame "Convenes with interdisciplinary group to review comprehensive nursing assessment and revise the initial plan of care within established time frame "Documents assessment and reassessment using established formats. "Prioritizes patient/family assessment based on patient condition. "Utilizes physical assessment techniques of auscultation, percussion, palpation and inspection. "Focuses assessment on patient and family. "Assesses psychological and spiritual status through active listening; open ended questions and other communication techniques. "Assesses educational/health needs and learning readiness. "Integrates age specific assessment into database. "Complies with department standards related to assessment. "Completes ongoing assessment based on plan of care, patient/family status and department standards. "Supports referral process in a manner that promotes timely admissions and positive contract and physician relations. "Incorporates interdisciplinary group and contract providers into all aspects of assessment and reassessment. Implementation "Facilitates the provision of care that promotes safety and wellness. "Facilitates familys confidence in their role in providing care. "Provides consultation services as requested based on standards. "Implements the plan of care using collaborative approach. "Delegates care to nursing staff based upon knowledge of competence and skills required. "Facilitates goal directed patient/family care associated with care protocols and/or collaborative interdisciplinary groups plan of care. "Provides direct patient care consistent with the plan of care utilizing established standards of care/practice. "Teaches patient, family, groups of individuals, and staff based on established plan. Evaluation "Based on input from interdisciplinary team members, including physicians, and patient/family determines if the goals established for the plan of care are being met in a timely manner. "Evaluates patients appropriateness for referral to hospice, palliative and/or other services in collaboration with the patient, family and other members of the interdisciplinary group "Evaluates patient and family response to care, overall progress toward desired outcomes, and the effectiveness of interdisciplinary groups care and services from referral through death/discharge. "Participates in interdisciplinary group staffing; collaborates with health care providers, contract employees and third party payers to identify issues and solutions to optimize outcomes. "Monitors the provision of services provided by contract employees. "Revises the plan of care with the interdisciplinary group to reflect patient/family changes and progress toward established goals. "Evaluates response to teaching activities. ReqEducation "Knowledge of patient care standards normally acquired through completion of a Diploma, Associate Degree or Bachelors Degree in Nursing, an active Wisconsin and or Michigan nursing license and current CPR certification. Experience"Previous experience working in home health or hospice and five years of broad based nursing experience with additional training or experience with the terminally ill beneficial. Required"Possesses an active Wisconsin RN nursing license. "Possesses an active Michigan RN nursing license or obtained within 90 days of hire (Rhinelander Home Health only) "Current BLS certification or obtained within 90 days of hire - All clinical personnel in identified job codes are required to maintain Basic Life Support (BLS) training through independent study, manikin and knowledge testing. An acceptable CPR training program is the Basic Life Support (BLS) Health Care Provider course from the American Heart Association or the client Professional Rescuer Program with AED. (See Cardiopulmonary Resuscitation Training Policy). Drivers License Required "Possesses a valid Wisconsin or Michigan Drivers License required. "Is able to travel to patient/client homes to provide patient/client care. "Possesses automobile liability insurance with minimum ***/*** coverage required.