Home Health Occupational Therapist (OT) Clinical Case Manager

JOB DESCRIPTION

Home Health Occupational Therapist (OT) Clinical Case Manager

JOB SUMMARY:

We are seeking a skilled and compassionate Occupational Therapist to join our home health care team. As a Home Health Occupational Therapist (OT) Clinical Case Manager, you will play a pivotal role in closely managing patients' chronic illnesses, with a primary focus on reducing the risk of hospitalization by identifying and addressing real-life challenges that act as barriers to better health outcomes. Employing a holistic approach, you will conduct comprehensive assessments to gain insights into the social determinants of health impacting patients' well-being. You will collaborate with patients, families, and interdisciplinary healthcare teams to develop and implement personalized care plans that promote well-being, with decreased risk for hospitalization and ED visits.

QUALIFICATIONS:

• Valid license to practice as a Occupational Therapist (OT) in the state of Maryland

• Two (2) years’ occupational therapy experience, preferred.

• Acceptance of philosophy and goals of this Agency.

• Commitment to providing compassionate, patient-centered care and upholding ethical standards of occupational therapy practice.

• Strong assessment, critical thinking, and problem-solving skills, with the ability to adapt to changing patient needs and clinical situations.

• Strong clinical skills in evaluation, assessment, and treatment planning, with proficiency in a variety of occupational therapy techniques and modalities.

• Excellent communication and interpersonal skills, with the ability to establish rapport with patients, families, and interdisciplinary team members.

• Reliable transportation and a valid driver's license, with the ability to travel to patients' homes within the assigned geographic area.

• Ability to work independently with minimal supervision, as well as collaboratively within a multidisciplinary team environment.

• BLS/CPR certification and other relevant certifications/licenses may be required.

RESPONSIBILITIES:

• Conduct comprehensive assessments of patients' health status, including physical, emotional, and psychosocial needs, in their home environments, using the current Outcome Assessment Information Set (OASIS)

• Conduct comprehensive evaluations of patients' physical abilities, including range of motion, strength, balance, coordination, and functional mobility, in their home environments.

• Assess and identify potential risk factors for hospitalization and emergency department visits through comprehensive evaluations and ongoing monitoring of patients' health status and functional abilities in their home environments.

• Identify real-life challenges and social determinants of health such as financial strain, lack of access to transportation, social isolation, and limited health literacy that hinder effective chronic illness management.

• Develop individualized care plans in collaboration with patients, families, and healthcare teams, tailored to meet the unique needs and goals of each patient, focusing on maximizing functional independence and decreasing risks of hospitalization and ED visits.

• Processes orders and notifies physician of patient needs and changes in condition. Completes certification/recertification orders and discharge summaries.

• Provide skilled occupational therapy interventions, including therapeutic exercises, manual therapy techniques, gait training, transfer training, and modalities, to address impairments and promote optimal movement patterns.

• Monitor patients' vital signs, symptoms, and overall condition, and adjust care plans as necessary to ensure optimal health outcomes.

• Educate patients and caregivers about their conditions, treatment plans, and techniques for managing symptoms, promoting self-care, and preventing injury or re-injury.

• Document all patient care activities accurately and timely in electronic health records (EHR) systems, in compliance with regulatory standards and organizational policies.

• Collaborate with interdisciplinary healthcare teams, including nurses, occupational therapists, speech therapists, home health aides, and social workers, to coordinate care and achieve holistic patient-centered outcomes.

• Assess and address safety hazards and environmental factors in patients' homes to ensure a safe and supportive care environment.

• Provide emotional support and counseling to patients and families, helping them cope with the challenges of illness, disability, and aging.

• Participate in interdisciplinary team meetings, case conferences, and continuing education activities to enhance clinical knowledge and skills, and contribute to quality improvement initiatives.

• Understands and adheres to established Agency policies and procedures.

• Supervises and teaches other therapy personnel.

• Participates in peer review and Quality Assessment and Performance Improvement as assigned.

WORKING ENVIRONMENT:

Works indoors in Agency office, remotely and patient homes and travels to/from patient homes.

JOB RELATIONSHIPS:

Supervised by: Director of Clinical Services/Clinical Manager

Workers Supervised: occupational Therapy Assistant, Home Health Aide

RISK EXPOSURE:

High risk

LIFTING REQUIREMENTS:

Ability to perform the following tasks if necessary:

Ability to participate in physical activity.

Ability to work for an extended period of time while standing and being involved in physical activity.

Heavy lifting.

Ability to do extensive bending, lifting and standing on a regular basis.

I have read the above job description and fully understand the conditions set forth therein, and if employed as a Registered Nurse, I will perform these duties to the best of my knowledge and ability.