Position Title: Per Diem Case Manager

Clinical Lynn - Job Code #: CL

Location: Lynn, MA
Department: Clinical
All Care Division: VNA

HOURS/SCHEDULE: Per Visit
Shift:

JOB PURPOSE:Per Visit Community Health Nurse to provide quality nursing care to identified home health client's in their home. The scope of nursing includes, direct client care, advocacy, and communication with the primary nurse. Client includes individual and family/significant other. Per Visit CHN reports to a Clinical Manager or Weekend Nurse Manager as assigned. Weekend and holiday commitment as per agency policy. There is no productivity requirement.

AGENCY EXPECTATION OF EMPLOYEE
All Care expects each employee to maintain a positive, respectful attitude, to demonstrate flexible and efficient time management, to meet departmental productivity standards, while keeping current the clinical skills to work in the home care environment. Each employee is expected to maintain open, honest and appropriately confidential communications with all customer groups in order to foster an effective service environment.

ESSENTIAL DUTIES AND RESPONSIBILITIES

Case Management 

  • Collects data and completes clinical assessments in a timely manner; formulates a plan of care using the identified client problem list, based on their assessment.
  • Develops and implements a Plan of Care for each client. The plan reflects goals identified by the clinician, the client's family and other disciplines involved in the client's care. Evaluates effectiveness of plan through clients response.
  • Reviews and modifies discharge plan in collaboration with client/family/significant other and all disciplines involved and the client's physician.
  • Coordinates and supervises other disciplines in a timely manner.
  • Reviews with client's physician information regarding the client's status and discharge plan, notifies physician of health status changes as they occur.
  •  Keep primary clinician informed via voice mail
  • Demonstrates ability to organize and set priorities to accomplish work in a timely manner.
  • Attend team meetings as requested.

Patient Care 

  •  Updates and revises the client Plan of Care and expected outcomes to meet changes in the client's status and the effectiveness of care being provided by all disciplines.
  • Continually reassesses the client's progress towards expected outcome and documents this at every visit in nursing progress notes utilizing the nursing process.
  • Participates in the planning, implementation and coordination of health teaching and counseling of client's family or significant other.
  • Initiates appropriate referrals for additional services or community resources.
  • Evaluates and revises as necessary teaching plans established to assist client to reach established goals.
  • Communicates clearly and accurately with other members of the health care team and with the client/family.

Professionalism
Complies with infection control and safety measures in accordance with the Agency’s policies and procedures. 

Initiates appropriate referrals for additional services or community resources.

Maintains high level of clinical expertise necessary to meet the needs of the client population and recognizes need for ongoing professional education and development within the Agency and in the community.

IV/Phlebotomy Aseptic Technique Med. Knowledge/administration
Recognizes personal strengths and weaknesses, independently seeks out appropriate resources. Shares professional experience, skills and knowledge with other staff members. Assists in orientation of new staff as requested by supervisor or team leader. Participates in the Agency’s Quality Improvement and Peer Review Programs. Precepts clinicians as requested.

Documentation

  • Documents client's level of understanding and response to teaching.
  • Documents goals and outcomes outlined on the plan of care established with the client, the family, and their physician.
  • Complete and submits documentation on a timely basis with clear, legible and concise information.
  • Completes documentation in accordance with Federal and State regulations and Agency's policy.
  • Any other duties/responsibilities assigned by supervisor

QUALIFICATIONS
Experience, Education and Licensure
Graduate of an NLN accredited school of nursing RN currently licensed in the state where client services are being rendered, current Driver's License. BSN from accredited school preferred. One to two years of recent clinical experience. CHN experience preferred. Must be familiar with MS Word, Outlook and Excel.

Language Skills
Ability to read and interpret documents such as safety rules, operating and maintenance instructions, and procedure manuals. Ability to write routine reports and correspondence. Ability to speak effectively before groups of customers or employees of organization.

AMERICANS WITH DISABILITY SPECIFICATIONS
Physical Demands
The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. The employee must regularily lift and / or move 50 pounds and frequently lift and / or move up to 100 pounds. Specific vision abilities required by the job include close vision, distance vision, color vision, peripheral vision, depth perception, and the ability to adjust focus.

Work Environment
Work environment characteristics described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is exposed to weather conditions prevalent at the time. The noise level in the work environment is usually moderate

The employee is expected to act as a role model and to adhere to all Agency policies.

Contact Information:
Please contact Laurie Proulx, All Care Recruiter
All Care, 210 Market Street, Lynn, MA 01901
Email: lproulx@allcarecareers.org
Phone: 781-244-1150
Fax: 781-586-1636

Not ready to apply? Need more information? Please contact us.

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