Full Job Description - Home Health RN Patient Case Manager Company Overview Thrive Health Care Services is a Joint Commission-accredited home health agency and a preferred post-acute care partner for hospitals, physicians, and families in Northern Virginia. We provide skilled home health, private duty nursing, personal care, and community-based services, delivering high-quality, cost-effective care that empowers patients to manage their health at home. Our Joint Commission Gold Seal of Approval® reflects our commitment to the highest standards of patient safety and care quality. Hospitals, health systems, physicians, and families throughout the region partner with Thrive because we are united by a single, shared purpose: it's all about helping people. Position Summary The Home Health RN Patient Case Manager is responsible for the overall supervision and coordination of clinical services for an assigned patient caseload. The Case Manager coordinates and supervises an interdisciplinary team to ensure continuity of high-quality care in accordance with the physician-prescribed plan of care and all applicable state and federal regulations and Joint Commission standards. Essential Functions Receives referrals and ensures appropriate clinician assignment for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits. Coordinates determination of home health benefits, medical necessity, and ongoing insurance authorizations. Ensures patient needs are continually assessed and that care delivered is individualized, appropriate, reasonable, meets home health eligibility criteria, and complies with physician orders. Oversees the development, implementation, and updating of each individualized plan of care. Manages and documents communication from physicians, clinicians, patients, and referral sources, and relays patient updates and new orders to clinicians using coordination notes as appropriate. Reviews assessments and plans of care daily per assigned workflow and consults clinicians and the Director of Nursing (DON) with recommendations as appropriate. Coordinates all aspects of care across disciplines, physicians, DME providers, caregivers and family members, transferring facilities, and other healthcare providers. Follows up on labs and diagnostic results, physician contact, and significant changes in patient condition to ensure timely physician notification, follow-up, and plan-of-care modification, and communicates changes to clinicians. Schedules, prepares for, facilitates, and documents case conferences and SOC reports, ensuring effective exchange of information across disciplines—particularly for adverse findings, changes in condition, and urgent updates. Assists clinicians in coordinating patient transfers and discharges as directed by the physician. Receives report from field clinicians prior to scheduled days off regarding patient status and ongoing needs. Writes and processes orders when taking verbal orders directly from the physician and communicates them to field staff. Ensures payer change documentation is completed accurately and timely. Reviews field nurses' notes weekly to ensure timely, complete, accurate documentation; takes corrective action on adverse findings and reports trends to the clinical director. Reviews, evaluates, and supervises service delivery for appropriateness and proper utilization through random patient visits, medical record reviews, and case conferences. Enters infections and incidents/occurrences into the agency's incident reporting system as specified by policy. Assists in the orientation of new agency personnel. Provides direction and leadership to clinical team members in collaboration with the clinical director. Provides direct patient care as needed, within scope of practice and physician orders. Participates in the agency's Quality Assessment and Performance Improvement (QAPI) program and supports ongoing Joint Commission survey readiness. Directs clinicians in applying evidence-based, best-practice interventions when finalizing plans of care. Participates in the on-call rotation and follows up on on-call events daily. Receives report from weekend and after-hours clinicians admitting new patients. Completes all Thrive-required learning courses, additional assignments per DON request, and any state-specific training required under Virginia regulation and the Nurse Practice Act. Performs all other duties as assigned. Education & Licensure Requirements Current, unencumbered RN licensure in the Commonwealth of Virginia Current CPR certification Valid driver's license, current vehicle insurance, and access to reliable transportation

Job Type:

Full-time Schedule:

Monday-Friday, 8-hour shifts

Job Type:

Full-time Pay:

$84,194.00 - $88,094.00 per year

Benefits:

401(k) Flexible schedule Health insurance Mileage reimbursement Paid time off Referral program Vision insurance

Experience:

Nursing:

1 year (Required) Home health: 1 year (Preferred)

License/Certification:

RN License (Required) Ability to

Commute:

Fairfax, VA 22031 (Required) Ability to

Relocate:

Fairfax, VA 22031: Relocate before starting work (Preferred) Willingness to travel: 25% (Preferred)

Work Location:

In person