Job detail

Registered Nurse (RN) - Continuum Home Health Case Manager - Multiple Locations

UVA Health

#Registered Nurse #Care Plans #Interdisciplinary Team #Patient Care #Care Coordination #Healthcare #BLS Certification #Patient Education

Quick overview

The Home Care Registered Nurse delivers hands-on care to medically complex patients and leads an interdisciplinary home health team. Responsibilities include conducting assessments, developing care plans, implementing interventions, and monitoring patient progress.

Requirements summary

Candidates must be graduates of an accredited nursing program and hold a Bachelor of Science in Nursing within five years of hire. A minimum of one year of relevant experience and a valid Virginia RN license are required.

bachelor degreeRegistered NurseCare PlanningCommunication SkillsBLS CertificationPatient CarePatient EducationCare CoordinationQuality ImprovementProfessional DevelopmentInterdisciplinary CollaborationLeadership SkillsEvidence-based PracticeClinical AssessmentMonitoring Patient ProgressHome Health Care

Job description

***Hiring multiple RNs in various locations**
Care that meets patients where they are. Nursing that meets you where you thrive. UVA Health’s Continuum Home Health team is redefining what high-level nursing looks like outside the hospital walls. We are an academic home health agency, providing care in the community for 30 years. This role is designed for experienced RNs who value clinical autonomy, meaningful patient relationships, while working primarily from home and serving the community they know best. This is not episodic care. It is longitudinal, relationship driven nursing within one of the nation’s most respected academic health systems. The Role As a Continuum Home Health Case Manager RN, you serve as the clinical anchor for patients transitioning from acute care to home or managing complex conditions in their own environment. You work independently, yet never in isolation, supported by UVA Health’s robust interdisciplinary and academic infrastructure. In this role, you will: Manage a defined caseload of adult patients receiving skilled home health services across your local service area Perform comprehensive in-home assessments, care planning, and ongoing evaluation Coordinate care for patients across physicians, therapists, social workers, pharmacists, and acute care teams Deliver evidence‑based nursing care, patient education, and chronic disease management in the home setting Use clinical judgment to prioritize visits, respond to changing patient needs, and prevent unnecessary hospitalizations Document and communicate effectively using UVA Health’s integrated clinical systems What an average day looks like: Your day begins from home, planning visits within your assigned community. You may start with a post‑discharge patient requiring complex medication reconciliation, followed by a chronic disease management visit focused on education and symptom monitoring. Throughout the day, you collaborate with physicians and team members, adjusting care plans in real time. The pace is purposeful, the work is deeply personal, and the impact is immediate. Why UVA Health UVA Health brings academic medicine into the home, allowing nurses to deliver advanced, patient centered care beyond traditional clinical settings. What sets this role apart: Part of UVA Health’s integrated Home & Transitional Care programs, delivering advanced care to patients aging in place or recovering at home Supported by a nationally recognized academic health system with a strong culture of nursing excellence and professional governance Access to interdisciplinary collaboration and specialty expertise typically found only in large medical centers Participation in innovative care models, including telehealth and remote monitoring initiatives expanding access to care in the home A role that values clinical judgment, independence, and continuity of care rather than volume driven visits Service areas include: This position serves patients in Charlottesville and the surrounding communities, including: Albemarle, Culpeper, Greene, Madison, Orange, Louisa, Fluvanna, Nelson, Buckingham, Augusta, and Rockingham counties. Candidates are encouraged to live in or near the communities they serve, fostering trust, continuity, and local connection. Why People Love Living in Central Virginia Charlottesville offers a rare balance for healthcare professionals seeking both career fulfillment and quality of life. Located at the foothills of the Blue Ridge Mountains, the area is known for outdoor recreation, a vibrant food and arts scene, excellent schools, and a strong sense of community. Many nurses appreciate the ability to leave a meaningful shift and quickly transition to hiking, local restaurants, wineries, or time with family. Compared to many academic medical center cities, Charlottesville offers a more accessible cost of living and a welcoming environment to put down roots. MINIMUM REQUIREMENTS Education: Graduate of an accredited nursing program required. Bachelor of Science in Nursing required within 5 years of hire.

Registered Nurse (RN) - Continuum Home Health Case Manager - Multiple Locations

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