Job Description

RN- Home Health, Case Manager at Tufts Medicine Care at Home summary:

The Home Health Registered Nurse (RN) Case Manager provides comprehensive nursing services to clients in their homes, focusing on assessments, care planning, and patient advocacy to prevent hospitalizations. Responsibilities include patient evaluations, coordination of care with healthcare professionals, and managing medications, all while ensuring safety and effective communication with patients and families. The role requires active engagement with patients from diverse backgrounds and collaboration within a multidisciplinary team to enhance patient outcomes.

Why Join Us?

• Newly adjusted Sign On Bonuses

• Recently increased market salaries

• Generous benefits that are effective day one

• Fleet car program: company paid vehicle, includes insurance, business miles and maintenance. Must meet eligibility requirements

• Company laptop and phone

Job Overview  

Utilizing the nursing process, the Home Health Registered Nurse will manage and deliver comprehensive home health services, including

assessments, interventions, and supportive care to clients within their place of residence. Depending on the circumstances, duties may also

include telephone triage, problem solving, patient/caregiver advocacy and support, with emphasis of avoiding hospitalization. As a key

member of the health care team, this position must interact courteously and effectively with patients and their families as well as with coworkers

from all Agency departments, community resources, and with patients' physicians in order to facilitate safe and efficient patient care

while maintaining their own safety in the home and the community at large.

Location: Nashua- Salem NH Territory

Hours: Full-Time, Days, 40 Hours

Minimum Qualifications:  

1. Massachusetts/New Hampshire RN Licensure. 

2. Valid state issued Driver’s License. 

3. One (1) year of acute medical/surgical nursing experience. 

4. Cardiopulmonary Resuscitation (CPR) Certification.

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list. Other duties and responsibilities may be assigned.

Essential Functions:

• Assesses patients' physical, psychosocial needs in a sensitive, caring manner following established Standards of Nursing Practice and VNA procedures.
• Assesses patient/family learning needs, style and limitations and adjusts for delivery of information.
• Establishes realistic goals and develops plans of treatment in cooperation with the patient, family and members of the health care team.
• Adapts to new and unusual situations without affecting work performance negatively.
• Utilizes Security when and if needed for any potential unsafe situations.
• Collaborates with patient /family and other health care providers and/or community resources with planning of care and discharge.
• Completes physicians' orders, levels of care, and OASIS on all patients assigned, in accordance with patient care policies.
• Reconciles medications with patient and physician consistently.
• Demonstrates ability to cope with patient/family emotional stress and provide appropriate supportive care.
• Effectively manages assigned caseload, within the team model of care delivery.
• Establishes a daily work plan based upon patient/family priorities of service and total area needs.
• Promptly triages patient visits, messages, and phone calls according to priority and urgency.
• Demonstrates excellent physical assessment and care planning skills.
• Demonstrates current knowledge of pharmacology and medication administration and reconciliation.
• Demonstrates ability to cope with patient/family emotional stress and provide appropriate supportive care.
• Effectively manages assigned caseload, within the team model of care delivery.
• Establishes a daily work plan based upon patient/family priorities of service and total area needs.
• Promptly triages patient visits, messages, and phone calls according to priority and urgency.
• Coordinates care and discharge planning with other team members during case conferences.
• Acquires and maintains an expert working knowledge of all third part payers and regulatory bodies and agency policies on issues related to documentation and care provided.
• Communicates and collaborates with all disciplines in the home care setting on a regular basis or immediately if there are any critical needs or crisis interventions needed.

What We Offer:  

• Competitive salaries & benefits that start on day one!
• 403(b) retirement with company match
• Tuition reimbursement
• Fleet Car Program

Tufts Medicine is a leading integrated health system bringing together the best of academic and community healthcare to deliver exceptional, connected and accessible care experiences to consumers across Massachusetts. Comprised of Tufts Medical Center, Lowell General Hospital, MelroseWakefield Hospital, Lawrence Memorial Hospital of Medford, Care at Home - an expansive home care network, and large integrated physician network. We are an equal opportunity employer and value diversity and inclusion at Tufts Medicine. Tufts Medicine does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation by emailing us at [email protected] .

Keywords:

Home Health Nurse, Registered Nurse Case Manager, Patient Care, Nursing Assessments, Care Coordination, Healthcare Team, Patient Advocacy, Telehealth, Medications Management, Home Health Services

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