At the direction of the Clinical Manager, screens, evaluates, re-evaluates and treats patients referred by a licensed provider. Coordinates and communicates treatment activities with health care team members and the patient. Works closely with the interdisciplinary team to ensure high quality patient care.
- Develops a care plan in collaboration with the patient's physician, the patient, and their family, or the primary caregivers upon admission.
- Periodically reviews the patient care plan and recertifies the patient care plan as appropriate.
- Coordinate the patient's care plan through interdisciplinary communication and case conferences, as appropriate. Advise other disciplines of discharges in a timely manner.
- Provide ongoing assessment of the patient's clinical, functional, and emotional status to identify problems and/or progress toward desired goals. Communicate significant changes to the patient's physician and VNA colleagues.
- Document evaluations, treatment goals, and objectives.
- Teach the patient and caregiver self-care techniques as appropriate. Provide medication, diet, and other instructions as ordered by the provider and utilizes opportunities for health counseling with patients and caregivers.
- Provides clinical oversight of LPNs and LNAs in the home.
This job description is not meant to be exhaustive and may be modified as needed. Employees may be assigned other related duties to meet organizational needs.