*Description*
Summary:
Achieve the physical, mental and social well being of the client within Agency policy. Supports utilization of medical resources through application of clinical expertise. Monitors clinical, functional and financial outcomes. Assumes responsibility for the ongoing interdisciplinary assessment and development of the individualized plan of care in partnership with the patient, representative (if any) and caregiver. Communicates with the physician who is responsible for the home health plan of care and other health care practitioners as appropriate related to the current home health plan of care.
Responsibilities:
1. Assessment of physical, emotional, socio-economic needs and environmental needs of patients and their families.
2. Provides services that are ordered by the physician as indicated in the plan of care. Communicates with all physicians involved in the plan of care and other health care practitioners as appropriate.
3. Develops,...