Complete comprehensive patient assessments, including accurate OASIS clinical and functional evaluations.

Review referrals and initiate patient and family contact.

Develop and implement individualized plans of care in collaboration with patients, families, physicians, and care team members.

Perform OASIS assessments throughout the patient's episode of care to ensure consistency and quality outcomes.

Provide skilled nursing visits, assess patient progress, and evaluate responses to treatment.

Educate patients and caregivers on disease management, treatment plans, and health promotion.

Coordinate care with physicians, therapists, and other healthcare professionals.

Supervise LPNs and Home Care Aides in carrying out the established plan of care.

Maintain accurate and timely clinical documentation and reporting requirements.

Participate in care conferences, interdisciplinary team meetings, SBAR reports, and quality improvement initiatives.