RN Case Manager

Home Health RN Case ManagerHome is Where the Heart Is! At West River Care, we've been a family-run organization for generations, and our mission has always been simple: to care for people where they feel most at home. Whether you're looking for help to live independently, manage your health, receive home care services, or find support during life's most challenging times, we're here for you every step of the way.Job Summary:The Home Health RN is responsible for delivering skilled nursing care to patients in their homes under the direction of a physician and in compliance with agency policies. The RN coordinates care, evaluates patient conditions, and educates patients and families about disease management and recovery.Key Responsibilities:Perform initial and ongoing nursing assessments of patient's physical, emotional, and environmental needsDevelop, implement, and update individualized care plans in collaboration with the patient, caregiver, and physicianDeliver direct nursing care, including wound care, medication administration, IV therapy, catheter care, injections, etc.Monitor and document patient vital signs, symptoms, and responses to treatmentsEducate patients and families on disease process, medication regimen, and self-care techniquesCommunicate effectively with the healthcare team, case managers, and physiciansEnsure timely and accurate documentation in the EMR in compliance with Medicare, state, and agency guidelinesParticipate in case conferences, in-service training, and quality assurance activitiesMaintain infection control and safety standards in the home settingMay supervise or delegate tasks to LPNs, home health aides, or other support staffQualifications:Current RN license in the state MassachusettsBLS certification requiredMinimum 1 year of clinical nursing experience (home health preferred)Familiarity with OASIS documentation (strongly preferred)Reliable transportation and valid driver's licenseStrong clinical judgment, time management, and independent decision-making skillsEMR proficiency (e.g., Matrix Care, Homecare Homebase, or similar)Preferred Skills:Experience with chronic illness management (e.g., CHF, COPD, diabetes)Work Environment & Physical Requirements:Frequent driving between patient homesAbility to lift up to 50 lbs, assist patients in mobility, and perform CPR if neededExposure to various home environments and occasional pets, smoke, or allergens