Position Summary We are seeking an experienced Registered Nurse to serve as a field/assessment RN responsible for completing Start of Care (SOC), Resumption of Care (ROC), Recertification, Transfer, and Discharge assessments. This role is best suited for an RN who already understands CHAP accreditation standards, Medicare Conditions of Participation (42 CFR Part 484), and Ohio Medicaid home health regulations — and who can produce accurate, defensible documentation the first time. The RN reports to the Director of Nursing and works closely with scheduling, intake, and billing to keep authorizations, plans of care, and physician orders current. Key Responsibilities Assessments & Episode Management Complete timely and accurate Start of Care (SOC) admissions, including full head-to-toe assessment, medication reconciliation, home safety evaluation, and patient/caregiver education Perform Recertification assessments within the required window to maintain continuity of care and reimbursement Complete Resumption of Care (ROC) visits within 48 hours of hospital or facility discharge notification Process Transfer documentation when a patient is admitted to a hospital or inpatient facility, and manage Discharge assessments Complete OASIS-E data collection accurately and submit within agency and CMS timeframes Care Planning & Coordination Develop and update the individualized Plan of Care (CMS-485) ; obtain and follow up on physician orders and signatures Coordinate with physicians, case managers, discharge planners, therapy, and family caregivers Supervise LPNs and Home Health Aides, including required supervisory visits and aide care plan updates Communicate authorization needs, frequency changes, and clinical status updates to the office in real time Compliance & Documentation Document in the agency EMR ( Axxess ) during or immediately following each visit, meeting all point-of-care and timely-documentation requirements Maintain compliance with CHAP accreditation standards , Medicare CoPs, Ohio Medicaid / ODM rules, and managed care payer requirements (CareSource, Anthem, Buckeye, Molina, MyCare Ohio) Ensure clinical records support medical necessity, homebound status (where applicable), and skilled need Participate in QAPI activities, chart audits, case conferences, and survey readiness Adhere to infection control, HIPAA, and agency policy and procedure at all times Qualifications Required Current, unencumbered Registered Nurse (RN) license in the State of Ohio Minimum 1 year of home health experience performing SOC/Recert/ROC assessments Working knowledge of

OASIS-E , CMS-485

plans of care, and Medicare/Medicaid home health documentation requirements Familiarity with CHAP (or ACHC/Joint Commission) accreditation standards and survey expectations Current BLS/CPR certification Valid Ohio driver's license, reliable transportation, and current auto insurance Ability to pass BCI/FBI background check and required health screenings (TB, drug screen) Strong computer skills and comfort with EMR documentation Preferred Experience with Axxess EMR Prior experience in a Medicare-certified agency that has completed a CHAP survey Knowledge of Ohio Medicaid managed care authorization workflows OASIS certification (COS-C / HCS-O) Wound care, IV therapy, or infusion experience

Pay:

$38.00 - $43.00 per hour

Work Location:

In person