LIFE Senior Care, a program designed to assist seniors with their customized healthcare needs, located in Jersey City Medical Center, is currently seeking a RN Case Manager!
Through the power of the Holy Spirit and in response to God’s love as revealed in the Gospel, the mission of Lutheran Social Ministries of New Jersey is to serve those in New Jersey who hurt, who are in need, or who have limited choices.
LSMNJ team members are dedicated to providing healing, hope and hospitality, regardless of religious background through a diversified social ministry program addressing many critical human care needs.
We are seeking employees that share those same values and want to make a difference in the lives of those we serve.
This position is full-time offering competitive compensation, a robust benefit package and generous paid time off.
Under the direction of the Nursing Director, the Homecare Coordinator will provide comprehensive nursing care to our participants at home and or in the center. They will perform the initial assessment, annual reassessment and change of condition assessments of participants in their home environment and coordinate individualized plan of care with appropriate resources. The Homecare Coordinator is required to educate and instruct participants in care and management of their disease and medications. The Homecare Coordinator directs and oversees the coordination of care and services for participants under his/her care. In conjunction with the Director of Nursing, the homecare coordinator shall act as the liaison between the contracted services and Lutheran Senior LIFE.
- Supports the mission and values of Lutheran Social Ministries of New Jersey, which is: Through the power of the Holy Spirit, and in response to God’s love as revealed in the Gospel, the mission of the Lutheran Social Ministries of New Jersey is to serve those in New Jersey who hurt, are in need, or have limited choices.
- Assesses participant’s physical and functional and psychosocial, needs, home safety, family caregiver burden, etc utilizing the nursing process, professional knowledge, observations and interviewing skills.
- Completes assessment documents including NJ Choice Level of Care, Home Safety Assessment, Home Care Skilled Nursing Assessment, and other documentation required for appropriate data collection and analysis as part of a quality assessment and performance improvement program.
- Develops and implements the home care components and works with other team members to develop a comprehensive Interdisciplinary plan of care based on the needs of participant initiating attainable goals that are mutually acceptable to the participant/caregiver..
- Communicates effectively with the Interdisciplinary Team (IDT) on care planning needs and desired outcomes. Reviews and revises goals and approaches to participant/caregiver in coordination with interdisciplinary team members.
- Communicates with primary care physician and clinic staff as needed to coordinate medication, ancillary tests and functions such as home blood draws as needed.
- Directs the provision of personal care, nursing rehabilitation tasks and other work of Home Health Aides and participant caregivers in the home.
- Coordinates the medication delivery and administration processes for participants requiring assistance at home.
- Coordinates with the Interdisciplinary team on obtaining of Advance Directives; educates member/ caregiver on their right to develop Advance Directives which may include Health Care Proxy, Living Will, DNR, Durable Power of Attorney and/or Burial Plans.
- Assess and instruct participant and caregiver on applicable disease management and care directed to the individualized needs of each participant under care. Ensure that each participant understands their rights and the role of each member of the IDT in their care.
- Documents changes in the participant’s condition and details care provided by completing all required PACE documentation and ensuring compliance to Agency standards and policies.
- Assessing participants in their home (HOME means where the participant resides. This may be a residential or a facility) in Hudson County. Travels to participants’ homes and/or other facilities with varying environments (e.g., elevated buildings, walk-ups, care facilities, single/multiple family homes, presence of pets, etc.) using approved transportation options to deliver direct care to the participant as appropriate within the regulations.
- Case Manages assigned participants in home care assuring all identified needs are met and maintain productivity sufficient to meet program goals.
- Communicates with Primary Care Physician (PCP) regarding participants medical needs as assessed to ensure comprehensive medical management. Assists the interdisciplinary team in understanding the significant nursing, self-care and functional needs of the participant.
- Ensures all contracted Home Health agency staff (if applicable) complete initial and annual competency testing.
- Maintains fiscal accountability for home care services provided.
- Participates in developing and organizing new staff orientation, training and on-going in-services training for staff, independent contractors.
- Maintains the confidentiality of all company procedures, results, and information about participants, clients or families.
- Adheres to Senior Healthcare’s Safety Policies and Procedures and Universal Precautions.
- Utilizes appropriate community resources and serves as a liaison between the program and other community agencies/services.
- Provides nursing services in accordance with NJ Department of Health and Senior Services requirements and nursing scope of practice and guidlines, agency policies, practices, and procedures.
- Documenting changes of a participant’s condition in the participant’s medical record consistent with documentation policies established in PACE guidelines.
- Participates in PACE meetings including but not limited to, interdisciplinary team meetings, family meetings, staff meetings, in-service and training programs, and quality improvement activities.
- Maintains flexibility in schedule and responds to unexpected emergencies and changes in workload in order to fulfill responsibilities.
- Participates in the on-call process.
- Complies with infection control and prevention principles and practices established in LSL policies and CDC.
- Maintains safe working environment. Follows Lutheran Senior Healthcare’s Safety Policies and Procedures.
- Participates in continuing education classes and any required staff and training meetings. Maintains professional affiliations and any required certifications.
Treats employees, patients, and business partners with respect. Fosters teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization. Embraces diversity and demonstrates the ability to work together.
Promotes a safe and efficient working environment by adhering to agency policies and procedures.
Maintains confidentiality of all agency and participant related information. Protects patient rights as defined in the patient Bill of Rights.
Maintains proper attendance and punctuality to ensure that the department is operated in an efficient and cost effective manner.
Adheres to departmental and agency dress code as outlined in the organization’s policy.
Completes annual compliance and HIPAA training and exhibits behavior as set forth by the LSMNJ Code of Ethics and Business Integrity in the performance of duties.
Adheres to the Organization’s Policies and Procedures regarding the Compliance Program of the organization and is timely in reporting any possible concerns.
Follows all local, state and federal regulations as they pertain to the position.
Adheres to the Organization’s Policies and Procedures covering Privacy and Security in Compliance with HIPAA regulations.
- Other duties as assigned by your supervisor, necessary for the efficient operation of the department/facility.
1. RN License, LPN or Licensed Social Worker in New Jersey
2. Current driver’s license and proof of auto insurance
1. Broad knowledge base of health care problems of the frail elderly.
2. Knowledge of common safety hazards in the home and improvements to establish a safer environment
3. Skilled in identifying problems and recommending solutions.
4. Knowledge of home care services, nursing principles and practices with particular reference to the elderly.
5. Ability to perform physical assessments and develop plans of care.
6. Knowledge of health instruction techniques and practices.
7. Skilled in preparing and maintaining records and written reports and responding to correspondence.
8. Excellent organization and documentation skills. Previous case management and leadership experience in Home Health Care
9. Familiarity with community health resources, which are available to participants and families
10. Skilled in developing and maintain department quality assurance. Knowledge of current NJ Home Health policies
11. Skilled in establishing and maintaining effective working relationships with participants, medical staff, staff members and family caregivers.
12. Ability to react calmly and effectively in emergency situations.
13. Work well with all members of the care team
14. Knowledge of elder abuse and reporting
15. Familiar with Dementia, Wandering Behavior and Intervention
16. Knowledge of Standard Precautions & Fire and Emergency Procedures in healthcare setting
17. Knowledge of Participant Rights and Workplace Safety
1. Minimum of 1 year of experience in acute care setting or
2. 1 year experience in home care or long term care setting
3. Minimum of 1 year working with the frail or elderly.
Employees must have medical clearance for communicable diseases and up-to-date immunizations before having direct participant contact.
LSMNJ is an equal opportunity employer.