• Completes and coordinates all applicable clinical assessments and clinical evaluations
• Trains, evaluates and supports Caregivers in conjunction with the care manager as needed on an on-going basis
• Coordinates consumer placement following acceptance to program and ensures that all required forms and standard procedures are followed for the placement process. Conducts orientation training for each caregiver before the caregiver enters the program as well as on-going training.
• Provide ongoing coaching to drive effective utilization of established best practices and protocols (carepaths) where appropriate
• Works collaboratively to develop and review on an ongoing basis, each member’s plan of care
• Reviews the caregiver notes daily and appropriately addresses changes in the consumer’s condition or environment
• Completes nursing progress note corresponding with each on-site visit or encounter, or more often as the member’s condition warrants
• Submits semi-annual health-status reports to each member’s PCP based on regulatory requirements
• Monitors the health status of all members to ensure that all needed AFC is properly delivered
• Reports changes in health status of any member to the member’s Primary Care Physician
• Coordinates the implementation of physician’s orders with the consumer, caregiver and other team members
• Plans and implements discharges and transition from the AFC program
• Ensures continuous survey readiness and compliance with accepted professional standards and practices and federal/state/local regulations including fraud, waste and abuse prevention; HIPAA and similar regulations; occupational safety and health standards; and company policies, procedures and performance standards.
• Perform other duties as assigned.

• Must hold an active Registered Nurse (RN) License in the state of employment
• Minimum two (2) years of recent experience in direct care of elders or adults with disabilities
• Ability to travel (usually by automobile) within assigned geographic area; valid driver’s license and automobile insurance is required
• Experience in case management, care planning and assessment for cases including but not limited to eldercare, people with disabilities, and other complex medical needs in a health care setting
• Proficiency in common software and web-based applications (e.g. MS Office, case management systems)
• Additional state-specific qualifications may be required.

Careforth is an Equal Opportunity Employer*

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  Careforth supports families with diverse backgrounds and as an equal opportunity employer, we seek employees who reflect the diverse population we serve. Careforth complies with all applicable laws concerning hiring and employment practices and is firmly committed to fostering and maintaining a workplace free from discrimination. We pledge to hire, train, and promote our employees without regard to race, religion, gender, gender identity, genetic information, age, national origin, sexual orientation, disability, veteran status, or any other category protected by applicable law.