| Job Description | Position Summary:
Provides direct care and case management for a team of Agency clients in accordance with the state Nurse Practice Act and Agency policy.
Essential Functions/Areas of Accountability
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1. Reviews client referral information and responds to requests and inquiries as appropriate.
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a. Collaborates with clinical supervisor regarding the eligibility and appropriateness of client for home care services.
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b. Completes comprehensive assessments including OASIS data set within forty-eight (48) hours of referral for speech therapy unless other arrangements are made.
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c. Determines appropriateness of referral for home care services and responds per Agency policy and standard guidelines.
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2. Performs initial and ongoing client assessments based on Agency policy and standards of practice to ensure effective and appropriate home care services.
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a. Performs comprehensive assessments including OASIS data collection where indicated.
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b. Considers the physical, psychological, and socioeconomic needs of the client, the level of family acceptance, and the ability for client needs to be met in the home.
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c. Collaborates with physicians, other health care professionals (therapists, social services, pastoral care, and supportive services), clients, and families in developing a comprehensive, coordinated plan for care.
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3. Directs, plans, and initiates appropriate action independently and responsively in home care situations
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a. Identifies and assesses over and subtle signs of impending physiologic and psychological changes. Notifies the physician in accordance with Agency policies and procedures.
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b. Makes decisions and/or recommendations reflecting consideration of immediate and long-range effects (frequency of visits, components of care plan, additional services.).
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c. Confers with the clinical supervisor on a regular basis. Utilizes agency and community resources appropriately.
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d. Monitors documentation of clinical records to ensure compliance with regulatory standards of timeliness, accuracy, and completeness.
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e. Provides on-call support for clients per schedule.
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f. Communicates with other disciplines/departments when required.
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4. Manages/supervises a team of RN’s, LPN’s, Home Health Aides, and Personal Care Aides to provide effective and quality home care services.
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a. Identifies the educational needs of team members. Provides training or refers to clinical supervisor to arrange specific training program. Provides or recommends educational resources.
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b. Performs or delegates in-home supervision of team members.
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c. Leads regular team meetings.
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d. Monitors the productivity of team members on a regular basis.
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e. Identifies staffing needs and communicates this information.
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5. Participates in human resource management to achieve quality service delivery and positive employee relations.
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a. Conducts timely performance evaluations consistent with Agency policy. Conducts in-home supervision of staff per Agency policy, regulatory requirements, and as needed.
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b. Applies disciplinary procedures in a fair and consistent manner when indicated. Documentation is completed per policy and legal guidelines.
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c. Collaborates with supervisors to identify staffing needs and evaluate qualifications and competencies of current and new employees.
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6. Promotes personal safety and a safe environment for clients and coworkers.
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a. Demonstrates knowledge of safety infection control practices by compliance with policies and procedures.
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b. Recognizes and responds appropriately to potentially unsafe situations.
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c. Demonstrates safe and competent practice in the use of equipment.
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d. Assesses safety of environment and takes initiative to prevent accidents and promote safety.
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e. Participates in all mandatory education per established guidelines.
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7. Performs job duties in accordance with Agency policies, procedures, and professional and community standards.
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a. Maintains confidentiality in all aspects of the job. Does not reveal information from client records to others, except as identified in Agency policy.
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b. Secures written confidential documents in a manner that prevents unauthorized release.
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c. Participates in the development, implementation, and evaluation of the quality improvement program and activities.
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d. Provides care in accordance with state, federal, CHAP, and JCAHO regulations.
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e. Follows established Agency guidelines for protection of confidentiality of all written and computer files.
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f. Protects personal password in accessing client and/or personnel files
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8. Performs other job duties as assigned.
a. Completes assigned tasks within established guidelines and time frames.
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