Job Description:

For over 45 years Pathways has been a Bay Area pioneer, leader, and innovator in Hospice, Home Health and Palliative Care. We provide care at home or in settings such as assisted living, a nursing home, or the hospital. We have offices in Sunnyvale, South San Francisco, and Oakland. Patients and their families know us for our personalized, high-quality care, delivered with empathy, kindness, and respect.TITLE: RN Case Manager - Home HealthOFFICE LOCATION: Sunnyvale, CAPATIENT TERRITORY: Mountain View - Redwood CitySCHEDULE: Full Time (hours are flexible)SHIFT: M-F, 1 Weekend Rotation Per MonthSign On Bonus: $9,000.00 (Conditions Apply)The posted compensation range of $56.95 - $78.30Hour is a reasonable estimate that extends from the lowest to the highest pay Pathways Home Health & Hospice in good faith believes it might pay for this particular job, based on the circumstances at the time of posting. Pathways Home Health & Hospice may ultimately pay more or less than the posted range as permitted by law.POSITION SUMMARY: In coordination and collaboration with the assigned Clinical Team Manager, is responsible for providing skilled nursing care to patients and their families. Coordinates care with other members of the home care team; supervises Home Health Aides. The majority of patient visit time is devoted to patient evaluations, admissions, and informational visits.AREAS OF RESPONSIBILITY:Makes initial admission visits. Notifies assigned Clinical Team Manager of OASIS scores within established timelines. Notifies appropriate team members of admission and follow up plans. Performs an initial, comprehensive assessment which includes but is not limited to the patient's eligibility for home care services in accordance with third party payer regulations, an accurate reflection of the patient's current health status, review of all medications the patient is currently using, an environmental assessment which includes physical, social and mental status, identified needs and potential to reach treatment and discharge goalsDocuments observations, clinical findings, problems, skilled interventions, goals and discharge plansIn consultation with the assigned Clinical Team Manager, initiates and regularly re-evaluates and revises the plan of careAssesses the need for the services of other team members (PT, OT, ST, MSW, and HHA)Provides and documents skilled care on all visits (includes skilled observation of the patient's condition, skilled care, and procedures and teaching of the patient andor family)Obtains and documents physician ordersPerforms Home Health Aide supervisory visits per regulatory requirementsCoordinates care with the assigned Clinical Team Manager, physician and other members of the home care team, informing them of significant changes in the patient's condition and needs. Documents these communicationsFollows established standards for point of service technology, documentation, and synchronizationUses agency provided telecommunication devices (i.e. cell phone, voicemail, and pager) according to established guidelinesSubmits weekly visit schedule of assigned patients. Collaborates with Clinical Team Manager to address scheduling needsPerforms re-certifications, resumption of care, transfers, and discharges as requested by the assigned Clinical Team Manager. Completes and submits all related documentationSubmits all documentation according to agency requirementsMeets established productivity standardsAttends and actively participates in the clinical team multidisciplinary patient conference. When attendance is not possible, provides appropriate input on assigned patientsDemonstrates established clinical competenciesSeeks out and maintains skills and knowledge relevant to skilled home care nursingParticipates in agency sponsored in-service educationParticipates in quality improvement activitiesAssists in development of agency protocols, procedures and policies as requestedAssesses, develops, organizes and delivers teaching materials for assigned home care patients as appropriatePerforms other duties as assigned consistent with skills and training and the mission and goals of PathwaysQUALIFICATIONS:Graduate of an NLN accredited nursing schoolCurrent California RN licenseMinimum one year hospice or home health experienceMeets competencies per Pathways guidelinesDemonstrates experience admitting patients in all settings to Pathways servicesExcellent clinical skills and demonstrated ability to manager time wellDocumentation skills must meet agency standardsGood organization skillsGood teaching skillsMaintains IV competencyPositive attitude and ability to confront problems constructivelyMust be highly motivated, self-directed, flexible, and able to work well and participate in a multidisciplinary team settingDemonstrates willingness and ability to work with electronic input and telecommunication devicesCurrent California driver's license and automobile insuranceCurrent CPR CertificatePowered by JazzHRDHxntX7Y3h