RN Home Health

Conducts Outcome and Assessment Information Sets and other required tools at the appropriate timeframes. Planning- develops a patient specific plan of care in collaboration with the patient and physician. Coordinates timely and accurate preparation of plan of treatment and recertifications as assigned.

Makes recommendations that may improve the patient's quality of life. Implementation- Oversees or carries out the treatment plan. performs physician ordered tasks maintaining principles of infection control. Treats patients and family members and caregivers with dignity, courtesy and respect.

Evaluation- Regularly evaluates the needs of the patient. Evaluates patient's progress to goals and prepares the patient for discharge. Completes discharge planning in collaboration with patient, physician, other nurses, social worker and other health care workers as applicable.

Participates in patient care conferences. Assists with coordination of patient-care activities/scheduling. Collaborates/cooperates to assure effective consistent management of patients.

Ensures care coordination occurs with all applicable disciplines. Reports issues following the chain of command. Under supervision, the Case Manager plans, organizes and manages a patient caseload: applies concepts derived from management and communications theory, group dynamics, counseling methodologies, and clinical nursing judgment to implement a clinical nursing program or programs.

Provides direct patient care through use of nursing process, performs established nursing intervention utilizing current clinical knowledge. Initiates and participates in patient, family and staff education. Demonstrates leadership capabilities.

Serves as preceptor for orientees and students.