Registered Nurse, Chronic Care Case Manager
: Job Details :

*** THIS POSITION MAY BE ELIGIBLE FOR UP TO A $15,000 SIGN-ON BONUS (restrictions may apply) ***The Registered Nurse Chronic Care Case Manager is responsible for direct patient care, coordination of services and documentation of care for a population of patients that have chronic and/or life limiting conditions as part of our CHHA. RN has basic knowledge in chronic disease management, palliative care, Medicare/Medicaid reimbursement criteria and community resources. Care is provided in accordance with agency policies, regulations, standards and under the guidance of a Clinical Supervisor in Onondaga County and surrounding counties. There is No On-call required.Performance Responsibilities and Standards:1. Ensure quality and safe delivery of home health services.Manage approximately 40-50 patients.Develop appropriate plan of care using evidence based guidelines based on client assessment and OASIS evaluation.Develop, implement, and communicate a plan of care using interdisciplinary approach including community resources and entitlement programs.Ensure that all documentation meets quality standards: OASIS evaluations are accurate, Documentation reflects nursing care and interventions, Documentation is clear and concise, Documentation is completed in timely manner.Understand and follow code of ethics and standards of practice.Demonstrate skill in motivational interviewing.Maintain established productivity expectationCommunicate with interdisciplinary team regarding client care issues.2. Responsible for coordination of team Support RN's and LPN's.Assign visits to team Support RN's and LPN's to meet agency productivity expectations.Provide guidance and education in client care to team Support RN's and LPN's.Work as a team and collaborate with physicians and other clinicians inside and outside the agency to ensure patients receive a coordinated combination of services that meet their health needs.Facilitate referrals to additional programs or services as appropriate to meet patient needs.3. Responsible for supervision of paraprofessional staff relevant to patient care.Monitor job performance of home health aides and delivery of home health aide services.Update care plans according to patient needs.4. Comply with Nascentia policies and procedures.Maintain confidentiality.Demonstrate knowledge and use of infection control practices.Demonstrate knowledge of federal, state and local government rules and regulations.Demonstrate knowledge and compliance with agency policies and procedures.Adhere to quality improvement standards.Keep personnel requirements up-to-date; i.e., health requirements, licensure requirements, CPR and others.Demonstrate skills competency through periodic evaluations.5. Participate in personal growth and development.Participate in educational in-services and meetings.Maintain and update clinical knowledge on an ongoing basis.6. Perform all other duties as assignedQualifications:Current New York State registered professional nurse license.Degree from an accredited school of nursing or college. Bachelor's degree preferred.Minimum of 2 years nursing experience preferably in acute care, home care or hospice.Current and valid driver's license and auto insurance and a vehicle which can be used for work.Good oral and written communication skills.Physical Requirements:Speaking/visual/hearing ability sufficient to comprehend and express written/verbal communication.Ability to perform tasks involving physical activity including: Pushing/pulling - Typical weight 50 pounds / Maximum weight 150 pounds; Lifting and carrying - Typical weight 25 pounds / Maximum weight 40 poundsPatient transfers, extensive bending, standing, kneeling, walking in various weather conditions e.g. snow, rain, sleet, and going up and down stairs.Ability to drive in all weather conditions throughout the working year.Bloodborne Pathogens Exposure Category I - Employee has tasks that routinely involve exposure or potential exposure to blood, body fluids or tissues.Compensation & BenefitsCompetitive Salary [This position is an S03 exempt position with a min-max rate of: $70,131-$81,275annually] with:$15,000 sign-on bonusRetention BonusesInternal Mentoring Program401K with generous Employer matchOn-Site Gym (free for all employees)Excellent work/life balance (no rotating shifts, only 2 required holidays per year on a rotating schedule)Medical, Dental, Vision plansTuition Reimbursement (BSN after only 6 months of employment!)Partially funded HSAEmployee Recognition PlatformPaid Time Off, Holidays, Sick and Extended Sick LeaveShort/Long term DisabilityEmployee Assistance Program (EAP)Much More!About Nascentia Health:Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.________________________________________________Nascentia Health is an Equal Opportunity Employer (EOE)Employment is contingent upon negative results of a pre-hire drug screen and background checkINDHP