Associate’s Degree or Diploma in Nursing minimum. New Mexico RN License required. Minimum three years acute care experience required and home healthcare experience required. Basic typing competency Need to have current driver’s license as well as auto insurance. Required to make visits after hours and on weekends to patients in entire agency coverage area.
*Previous homecare or hospice experience preferred.
Primary Job Functions
• 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 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 patient’s response to intervention.
• Provide direct patient care by assessing patient for care needs, resources to meet needs and developing a home healthcare plan of care in conjunction with physician; assures completion of required OASIS assessments according to the appropriate home healthcare program regulations.
• Coordinates implementation of the plan of care through a multidisciplinary home healthcare team, community resources and the physician
• Ensures plan of care is followed and that documentation complies with regulation for the applicable home healthcare program..
• Maintains a department and disease state defined productivity standard for visits and caseload management dependent on disease state population.
• Precepts new associate nurses, new case managers and students and serves as a resource person and professional role model as needed.
• Maintain communication with associates and assures that orders for necessary care plan changes are obtained; assures that changes are communicated timely and completely to other primary care managers and to associates
• Documents daily all care delivery so that receiving “staff” have record of care delivered; this includes admissions.
• Demonstrates proficiency and competency in interventions (treatments) required by home healthcare standards of practice 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, the applicable home healthcare program 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 holiday call for agency and patients’ home visits as required on a rotating basis.
• Maintains utilization standards within disease state management guidelines.
• Assure clinical outcomes and process measures are met and sustained for disease state.
• Manages caseload per agency program standard.
• Performs other functions as required.
Presbyterian Healthcare Services - 20 months ago