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Location

Santa Fe, NM | United States

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Job description

Responsible for case management of Home Healthcare patients. Ensures that care delivery is within quality and utilization guidelines and is directed toward the achievement of desired clinical outcomes for the disease state. Responsible for development, coordination and scheduling delivery of care through a multidisciplinary team to the patient in the home or community setting. The Case Manager assures completeness, timeliness and appropriateness of the patient care plan, its implementation and ongoing evaluation. Assures communication with the multidisciplinary team, support services and community resources to ensure that care goals are achieved in the most efficient and cost effective manner possible. Ensures that documentation is timely, accurate, complete and reimbursable. Is a patient advocate. Precepts newly hired nurses. .
PRN staff will not be responsible for managing a caseload; but all staff are required to manage the case load, follow up and communication for their daily assignments

Type of Opportunity: Part Time (.10 to .44)
FTE: 0.300000
Exempt: No
Work Schedule: Days

*Demonstrates nursing care management of patients as evidence by
a. Assessments that are complete, timely, and appropriate of physical, mental, psychological/social (behavioral), functional, financial, treatment, resource and spiritual needs of patients.
b. Analysis that defines problems that are capable of correction through home healthcare and hospice interventions and are prioritized in development of care plan.
c. Intervenes consistently with orders and changes interventions with orders to meet changes in patient need
d. Evaluates each visit the effectiveness of interventions and the patients response to intervention.

*Provide direct patient care by assessing patient for care needs, resources to meet needs and developing a home care or hospice plan of care in conjunction with physician. Assures completion of required OASIS assessments according to regulations for home care and QAPI measures for hospice .

*Coordinates implementation of the plan of care through a multidisciplinary home care or hospice team, community resources and the physician

*Ensures plan of care is followed and that documentation complies with regulation.

*Maintains a department productivity standard for visits and caseload management.

*Demonstrates professional accountability for self-scheduling patient case load with appropriate frequency and duration, and concurrently updates schedule throughout the day as needed so that ongoing patient needs can be met.

*Assure patients on case load are notified timely of their visits and of any unplanned schedule changes accommodating, when possible, patent preferences for time of day.

*Precepts newly hired nurses, and students and serves as a resource person and professional role model as needed.

*Maintain communication with the multidisciplinary team s and assures that orders for necessary care plan changes are obtained and assures that changes are communicated timely to the team.

*Initiates documentation in the home and completely records all care delivery so that receiving staff have record of care delivered by the end of each day which includes admissions.

*Demonstrates proficiency and competency in interventions (treatments) required through day to day practice and annual competency testing.

*Delegate or assign aspects of patient care to health care team members commensurate with their validated competency to perform the task.

*Be professionally responsible for current nursing research, current nursing standards, home care or hospice philosophy in order to maintain quality.

*Be responsible for clinical supervision of licensed and non-licensed assistive personnel.

*Participates in agency continuous quality improvement activities as required.

*Assume other leadership roles as required by the department.

*Responsible for weekend and holiday coverage and evening call for agency and patient home visits as required on a rotating basis.

*Assure clinical outcomes are met and sustained .

*Performs other functions as required.

*Minimum one year acute care experience within the last 3 years required and hospice or home care experience preferred.. Basic typing competency Need to have current drivers license as well as auto insurance.

 

Education:
Essential:
* Associate Degree

 

 

 

Credentials:
Essential:
* Registered Nurse-NM

We offer more than the standard benefits!

Presbyterian employees gain access to a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more!

Learn more about our employee benefits:

Why work at Presbyterian?

As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans. For our employees, we offer a robust wellness program, including free access to our on-site and community-based gyms, nutrition coaching and classes, wellness challenges and more.

Presbyterian's story is really the story of the remarkable people who choose to work here. The hard work of our physicians, nurses, employees, board members and volunteers grew Presbyterian from a tiny tuberculosis sanatorium to a statewide healthcare system that serves more than 875,000 New Mexicans.

About Presbyterian Healthcare Services

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.

About Our Regional Delivery System

Presbyterian's Regional Delivery System is a network of six hospitals and medical centers throughout rural New Mexico including locations in Clovis, Espanola, Ruidoso, Santa Fe, Socorro and Tucumcari. Our regional facilities are home to more than 1,600 clinical and non-clinical employees who help make Presbyterian the state's largest private employer with nearly 14,000 statewide employees. With a variety of services ranging from general surgery to pediatrics to heart and cancer care, our regional employees are proud to provide close-to-home care for their communities.

We are part of New Mexico's history - and committed to its future. That is why we will continue to work just as hard and care just as deeply to serve New Mexico for years to come.

About New Mexico

New Mexico continues to grow steadily in population and features a low cost-of living.

Varied landscapes bring filmmakers here from around the world to capture a slice of the natural beauty New Mexicans enjoy every day. Our landscapes are as diverse as our culture - from mountains, forests, canyons, and lakes, to caverns, hot springs and sand dunes.

New Mexico offers endless recreational opportunities to explore and enjoy an active lifestyle. Venture off the beaten path, challenge your body in the elements, or open yourself up to the expansive sky. From hiking, golfing and biking to skiing, snowboarding and boating, it's all available among our beautiful wonders of the west.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

USD $45.53/Hr.
The compensation range for this role takes into account a wide range of factors, including but not limited to experience and training, internal equity, and other business and organizational needs.

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