Supervising RN-Clinical Manager (OL37)

BASIC SUMMARY

The Registered Nurse (RN) provides skilled nursing services to home health patients in their place of residence. The RN follows the nursing process of assessment, planning, implementation, and evaluation, working in collaboration with the physician and interdisciplinary healthcare team to develop and update the patient’s plan of care.

The RN is responsible for ongoing patient assessments, skilled procedures, education, documentation, and coordination of services, ensuring compliance with state and federal home health regulations.

PRIMARY RESPONSIBILTIES/​ESSENTIAL JOB FUNCTIONS

Assessment & Plan of Care

1. Performs comprehensive head-to-toe assessments of the patient's physical, psychosocial, emotional, family, support system,

and environmental status for home care appropriateness.

2. Develops, implements, and evaluates an individualized plan of care in collaboration with the physician, therapists,

social medical workers, and home health aides, ensuring adherence to medical and nursing diagnoses, patient

needs, and standards of care.

3. Provides ongoing interdisciplinary assessment, revising the plan of care as patient needs change.

4. Establishes realistic goals for the patient and caregivers based on ongoing data collection during home visits.

5. Determines necessary nursing interventions and patient education to achieve expected outcomes.

6. Coordinates care and services provided by other healthcare team members, including physicians, therapists,

social workers, and home health aides.

7. Ensures compliance with documentation standards and maintains communication with the healthcare team.

Intervention

8. Performs skilled nursing procedures as ordered by the physician and in accordance with home health policies and

procedures.

9. Provides patient, caregiver, and family education on medical conditions, medications, self-care techniques, and

nutrition.

10. Prepares and maintains accurate clinical notes and progress reports for each patient visit.

11. Submits documentation, ensuring compliance with agency and regulatory timelines.

12. Monitors and records vital signs, pain levels, and wound measurements on each visit.

13. Ensures proper execution and documentation of physician orders, treatments, and medication administration.

14. Communicates significant patient condition changes immediately to the physician and interdisciplinary team.

15. Provides preventive and rehabilitative nursing procedures to promote optimal patient health.

16. Supervises and instructs home health aides and LPNs, ensuring patient care goals are met.

17. Completes supervisory visits to the patient’s residence at least every two weeks, assessing the home health

aide’s performance and patient progress.

Evaluation of Outcomes of Care

18. Documents patient and caregiver responses to interventions and teaching.

19. Evaluates patient progress toward goals and modifies the plan of care as needed.

20. Ensures the plan of care is reviewed and updated at least every 60 days or when significant changes occur.

21. Notifies the physician and team of any significant changes in the patient’s condition.

22. Participates in interdisciplinary team meetings and contributes accurate, concise reports on patient progress.

23. Completes discipline discharge documentation on the day of the discharge visit, submitting all required

documentation within 48 hours.

Resource Utilization & Compliance

24. Ensures compliance with Medicare, Medicaid, and agency regulations.

25. Manages and orders medical supplies based on patient needs and payer requirements.

26. Documents and updates medication profiles per physician orders.

27. Ensures all verbal physician orders are documented and submitted timely.

Leadership & Professionalism

28. Adheres to the Code of Ethical Behavior and maintains professional conduct at all times.

29. Participates in the agency’s Quality Assurance and Performance Improvement (QAPI) program.

HUMAN RELATIONS

1. Maintains a professional attitude and communicates effectively with patients, caregivers, colleagues, and supervisors.

2. Demonstrates optimism, enthusiasm, and teamwork to ensure a positive work environment.

PHYSICAL REQUIREMENTS

1. Works in varied home environments with different conditions (e.g., stairs, pets, heating/cooling variations).

2. Must have adequate vision and hearing to comprehend written and verbal communication.

3. Requires the ability to navigate homes, assist with patient mobility, and perform physical tasks as needed.

4. Requires someone who drives and has drivers license

QUALIFICATIONS

A qualified Registered Nurse (RN) must have successfully completed:

1. A graduate program from an approved school of professional nursing

2. Must possess a current and valid RN license to practice in the Commonwealth of Pennsylvania under the

Professional Nursing Law

EDUCATION AND REQUIREMENTS

1. Must be at least 18 years old.

2. Minimum one (1) year of clinical experience preferred but not required.

KEY PERFORMANCE INDICATORS (KPI'S)

1. Ensure 100% EVV Compliance with scheduled visits

2. Complete and finalize 100% of Start of Care and Reassessments in person by the designated due date.

3. Ensure 0 outstanding signed orders past due. (7 days after sent)

4. Achieve at least a 95% satisfaction rating on 100% of patient survey results from the previous week.

ADDITIONAL NOTES

- $50 monthly reimbursement to cover Wi-Fi & Personal Device use.

- Must have own laptop.

- Mileage reimbursement: If the drive distance to a client’s house is over 20 miles, reimbursement is provided at $0.25 per mile.

- Driver's license and personal vehicle required.

- Must have valid car insurance.