RN Case Manager
First Call Home Health
Salem , OR
09/01/21 - 02/21/24
- Monitored and evaluated effectiveness of treatment plans and interventions.
- Maintained accurate documentation of patient progress in the electronic health record.
- Developed discharge plans for patients transitioning from acute care settings to home or alternate facilities.
- Facilitated transitions between levels of care through effective coordination of resources within a managed care environment.
- Conducted weekly interdisciplinary team meetings to review case management activities for assigned caseloads.
- Assessed patient's physical, mental, and psychosocial health status to develop individualized care plans.
- Actively participated in multidisciplinary rounds discussing complex cases with members of the healthcare team.
- Provided direct nursing care such as wound dressing changes, IV therapy, medication administration and patient education.
- Collaborated with physicians, nurses and other healthcare professionals to ensure optimal patient outcomes.
- Provided emotional support and counseling to patients dealing with chronic illness or end-of-life issues.
- Coordinated medical services between primary care providers, specialists, hospitals and outpatient clinics.
- Educated patients on disease prevention strategies, wellness promotion techniques and lifestyle modifications.
- Communicated regularly with family members regarding patient care needs and progress toward goals.
- Created physician referral base for wellness, prevention and diagnostic support, enabling patients to effectively find services.
- Charted weekly progress notes and quarterly summaries.
- Assisted patients in navigating through the healthcare system by providing support throughout their treatment process.
- Created discharge plans that ensure continuity of care after hospitalization or clinic visits.
- Monitored patient progress and modified treatment plans as needed.
- Conducted specified laboratory tests to help detect conditions and determine diagnosis.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Supervised nursing assistants in providing safe patient care.
- Delivered information regarding care and medications to patients and caregivers in comprehendible terminology.
- Administered local, inhalation or intravenous anesthetics to patients undergoing procedures.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
- Performed wound care, including dressing changes and infection control measures.
