Home Health Care Case Manager 

***Certified Home Health Care Experience Required***
***EPIC or Netsmart Required**

A. Develops and revises plan of treatments and discharge plan in conjunction with patient, family, physician, care delivery team and third party payors including obtaining medical orders and approval of medical services.
B. Completes and submits OASIS assessments, reassessments, transfers, resumptions of
care, discharges and significant change in condition in accordance with Agency defined time frames.
C. Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries.
D. Provides an environment, which promotes respect for the patients, their privacy, confidentiality and property.
E. Initiates appropriate preventive and rehabilitative strategies.
F. Provides those services requiring substantial specialized nursing skills.
G. Consults with and educates the patient, family and other team members regarding disease process, self-care techniques and preventive strategies.
H. Provides supervision of LPN to ensure patient health, safety, and compliance with plan of care.
I. Directs, coordinates, evaluates and supervises the quality of patient care
services provided by the Home Health Agency.
J. Interacts with patients, physicians, referral sources, and others in a manner conducive to continued positive relationships.
K. Supports Care Management philosophy. This includes collaborative customer focused planning, and case management designed to meet individual health and service needs and promote quality and cost-effective outcomes.
L. Assures the completion of all appropriate clinical records needed for compliance with state and federal legislation and the delivery of seamless service within established timeframes.
M. Maintains current knowledge of all available URMHC and community-based services.
N. Demonstrates flexibility and willingness to visit patients based on need and not geography.
O. Ensures problem resolution at the point of contact.
P. Ensures authorization and release of information form has been signed by patient or responsible party.
Q. Attends patient care conferences on patients assigned to his/her care.