ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

• Responsible for providing comprehensive case management to home health patients.
• Completes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illness(es). Admits to appropriate level of service/ care.
• Regularly re-evaluates patient nursing needs.
• Initiates the plan of care and makes necessary revisions as patient status and needs change.
• Uses health assessment data to determine nursing diagnosis.
• Develops a care plan, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions. Includes the patient and the family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures.
• Administers medications and treatments as prescribed by the physician.
• Counsels the patient and family in meeting nursing and related needs.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Accountable for financial resources and eligibility under various third party payor sources, Medicare and Medical.
• Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient.
• Knowledge of state, federal, local and accreditation (CHAP) regulations for the delivery of home health services.

Communication

• Prepares clinical notes and updates the primary physician when necessary and at least every sixty days.
• Communicates with the physician regarding the patient’s needs and reports and changes in the patient’s condition; obtains/receives physician’s orders as required.
• Communicates with community health related persons to coordinate the care plan.
• Teaches the patient and family/ caregiver self-care techniques as appropriate provides medication, diet and other instructions as ordered by the physician. Recognizes and utilizes opportunities for health counseling with patients and families/ caregivers.
• Provides and maintains a safe environment for the patient.
• Assists the patient and family/ caregiver and other team members in providing continuity of care.

Additional Duties

• Participates in on-call duties as defined by the on-call policy.
• Actively participates in Quality Management program.
• Ensures that arrangements for equipment and other necessary items and services are available.
• Meets daily average productivity standard set by the organization.
• Supervises ancillary personnel and delegates responsibilities when required.
• Assumes responsibility for personal growth and development. Maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in-service classes.

• Graduate of an accredited school of nursing. One to two years of recent acute care experience.
• Current licensure in State, CPR certification and valid driver’s license.
• Bachelor’s degree, with one year of home health care experience preferred.
• Management experience not required. Responsible for supervising home health aides/ LVNs.
• Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist.

• Ability to lift 25 lbs.
• Ability to push/pull 200 lbs.
• Ability to stoop, bend, and squat.
• Ability to walk up one flight of stairs.
• Ability to walk one mile.
• Ability to sit for one hour, minimum.
• Visual and audio acuity.