The RN Case Manager serves as a clinical leader and resource within Care Team Operations. In collaboration with Care Team Directors, they provide clinical guidance and support to care teams. This role is responsible for ensuring the delivery of high-quality, patient-centered care while maintaining compliance with Department of Labor (DOL), EEOICPA, state regulatory, and Giving Home Healthcare standards.

The RN Case Manager oversees clinical documentation, supports care coordination, facilitates interdisciplinary collaboration, and serves as a subject matter expert for complex patient cases. Through proactive clinical oversight and mentorship, this position helps ensure optimal patient outcomes, regulatory compliance, and clinical excellence across care teams.

Primary Responsibilities

Clinical Oversight and Compliance

• Review Plans of Care (POCs), Letters of Medical Necessity (LMNs), and other clinical documentation for accuracy as needed.

• Review and approve monthly Case Management (CM) notes.

• Final reviewer of incidents in PHP, ensuring accuracy and completion.

• Conduct routine audits and spot checks of nursing documentation to ensure quality, consistency, and compliance with organizational and regulatory standards.

• Complete supervisory visits for patients without an assigned Registered Nurse and for patients assigned to a Licensed Practical Nurse (LPN).

• Conduct T1001 assessments as needed for patients without an assigned Registered Nurse, patients assigned to an LPN, and for cases requiring mid-authorization increases.

• Monitor patient status and identify clinical concerns requiring intervention, escalation or investigation.

• Collaborate with Care Team Directors and Clinical team to address patient care needs, clinical staffing alignment and education, and high-risk or red-flag cases.

• Communicate changes in patient condition to team members and stakeholders as appropriate.

• Ensure compliance with DOL, EEOICPA, home health regulations, and organizational policies and procedures.

Patient and Family Care Coordination

• Collaborate with patients, families, and caregivers to address clinical concerns, escalations, care planning, and service utilization.

• Provide education and guidance to patients and families regarding care plans, services, and clinical recommendations.

• Support continuity of care through effective communication among patients, families, providers, and care teams.

• Assist in resolving complex patient care issues to promote positive outcomes and patient satisfaction.

Care Team Support and Leadership

• Serve as a clinical resource and consultant for Care Team Directors, Patient Coordinators, and interdisciplinary staff/all staff.

• Support Care Team Directors in evaluating nursing and Home Health Aide (HHA) utilization to ensure appropriate allocation of authorized care hours and staffing resources.

• Provide clinical guidance and mentorship to nursing staff and care team personnel.

• Promote clinical collaboration and best practices across care teams.

• Participate in team meetings, case conferences, quality improvement initiatives, and organizational projects as assigned.

Qualifications

Required Qualifications

• Current, unrestricted Registered Nurse (RN) license in the state of practice (TX).

• Minimum of three (3) years of nursing experience.

• Strong knowledge of clinical documentation standards, patient assessment, and care planning.

• Excellent organizational, communication, and critical thinking skills.

• Ability to work independently while collaborating effectively with interdisciplinary teams.

• Proficiency in electronic medical record (EMR) systems and Microsoft Office applications.

Preferred Qualifications

• Bachelor of Science in Nursing (BSN).

• Experience in home health, case management, care coordination, long-term care, rehabilitation, community health settings or clinical leadership roles.

• Knowledge of Department of Labor (DOL) and Energy Employees Occupational Illness Compensation Program Act (EEOICPA) regulations and requirements preferred.

• Experience using IGEA or similar healthcare documentation platforms.

Core Competencies Patient-Centered Care

• Clinical Expertise and Judgment

• Leadership and Mentorship

• Collaboration and Relationship Building

• Regulatory Compliance

• Problem Solving and Critical Thinking

• Attention to Detail

• Time Management and Organization

• Effective and Inclusive Communication

• Adaptability and Accountability

Work Environment and Expectations

• Primarily office-based with regular travel to patient homes and community settings as needed. May require occasional overnight travel.

• Must be able to attend team meetings, case conferences, patient visits, and urgent clinical situations.

• Ability to sit, stand, walk, and travel between locations as required.

• May require occasional lifting, bending, and other physical activities associated with patient assessments and supervisory visits.

• Must maintain a valid driver's license and reliable transportation in accordance with organizational requirements.

$80,000 - $90,000 a year

Annual Salary: $80,000 - $90,000 annually

Eligible for 15% annual KPI bonus

To provide the exceptional care our patients deserve, we rely on a team of passionate, dedicated professionals. We're committed to creating a supportive, collaborative culture, offering competitive benefits and compensation, and giving our team members the tools and opportunities to grow and advance their careers.

If you're ready to be part of an organization that truly makes a difference in people's lives, we encourage you to apply today and start a fulfilling journey with Giving Home!