RN Case Manager Homecare – Fairview Health Services – Maplewood, MN

Maintains knowledge of, and complies with, all relevant laws, regulations, policies, procedures and standards.

Actively participates in creating and implementing improvements.

Reviews patient referral information and evaluates eligibility and appropriateness for home care services.

Performs patient assessment based on HealthEast Home Care’s framework of practice and applies standard nursing principles to ensure effective and appropriate home care services.

Maintains an individualized plan of care, related to the patients needs, in collaboration with the physician, patient and significant others. Determines appropriate utilization of resources based on clinical assessment and home care standards of care.

Continually reassess resource utilization as patient progresses towards goals. Reviews, prioritizes and implements POC based on payer limitations.

Recognizes and reports signs of impending physiologic and/or psychological patient changes to the appropriate physician.

Recognizes, evaluates and documents needs of patient and family to provide the most effective and appropriate patient home healthcare.

Maintains complete, accurate, legible and timely clinical records/documentation on all patients according to agency standards and/or policy.

Directs, plans and initiates appropriate action independently and responsively in home Care situations.

Collaborates with physicians, and other health care professionals, i.e., rehab, social work, and patients/ families in developing/maintaining a safe quality home care plan.

Educates the patient/caregiver on how to self-manage their own disease on a day-to-day basis.

Evaluates and documents on the patient’s medical record the physical, psychosocial and teaching-learning needs of patient and family.

Manages/supervises a team of RNs, LPNs and HHAs to provide effective and appropriate home care. Manages the visits assigned to those under direct supervision per agency policies/standards to ensure patient continuity of care and productivity of team members assigned under direct supervision.

Evaluates and documents on the patient’s medical record the physical, psychosocial and teaching-learning needs of patient and family.

Communicates to Case Manager and others on care team any changes in Plan of Care.

Supervises paraprofessional staff in patient care.

Fiscal Accountability: 1) is a good steward of resources: discipline utilization, visits and supplies within payer limits 2) maintains productivity standards.


Associate’s degree in Nursing

1 year nursing experience in acute/skilled facility within the past 5 years, which included observation and independent assessment complex cases such as surgical, behavioral, wound care, orthopedic or cardiac care (post-surgical). 2 years preferred


Current Basic Life Support (BLS) from the American Heart Association (AHA) or American Red Cross

Driver’s license, reliable transportation and automobile insurance, DMV check is required

Knowledge regarding Medicare/Medicaid and third-party payors

Demonstrated knowledge of evidence-based nursing practices and current patient care best practices

Knowledge of Microsoft Office Suite software, healthcare records systems, and basic computer skills

Bachelor’s degree


Additional home care and supervisory experience

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Internal Number: 2020-61974

Source: Indeed.com
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