A home health director of nursing leads the nurses, therapists and aides who care for patients at home. They decide which referrals the agency can safely take and who sees each new patient. They make sure assessments and care plans are done on time, and step in when a patient gets worse.
By the HireBus team · Updated · Pay data: BLS, May 2025
Median pay, home health care agencies · BLS, May 2025
We're looking for a Director of Nursing to lead our clinical team. You'll assign patients to nurses, therapists, and aides, keep every patient's plan of care current, and hold visit quality and documentation to standard. In many agencies this role also serves as the clinical manager under Medicare rules.
2. Essential Duties and Responsibilities
Assign patients to RN Case Managers, LPNs, therapists, social workers, and aides based on skills, caseload, and location.
Oversee start of care visits, OASIS assessments, and plans of care so they're accurate and on time.
Accept or decline new referrals based on whether the agency can safely meet the patient's needs.
Coordinate care across disciplines through case conferences, and step in on complex or high-risk patients.
Supervise and train nurses and aides, including aide competency evaluations and supervisory visit tracking.
Lead infection control and incident review, and the clinical side of quality improvement.
Write and update clinical policies and teach staff to follow them.
3. Key Tasks / Daily Activities
Review new referrals with the Intake Coordinator and assign start of care visits.
Check for overdue OASIS assessments, unsigned orders, and missed supervisory visits.
Take calls from nurses and therapists about a patient's change in condition, and decide on next steps.
Read a sample of visit notes and OASIS assessments for accuracy.
Approve weekend and after-hours clinical coverage.
4. Key Performance Indicators (KPIs)
Start of care within required time frames: [your target].
OASIS accuracy on review: [your target].
Acute care hospitalization rate: [your target].
Plans of care signed and returned on time: [your target].
Clinical staff turnover: [your target].
5. Required Qualifications and Skills
Active [State] RN license, or a multistate RN license under the Nurse Licensure Compact if your state is a member.
Meets your state's requirements for a director of nursing or clinical manager at a home health agency.
[3+] years of home health nursing, with [2+] years supervising clinical staff.
Strong knowledge of OASIS, plans of care, and the Medicare home health Conditions of Participation.
Current CPR certification (BLS).
Follows HIPAA and teaches the team to protect patient information in homes, cars, and on phones.
6. Preferred Experience
Bachelor of Science in Nursing (BSN).
COS-C certification for OASIS.
Experience with home health EMR software such as [your EMR].
Has led a clinical team through a state survey or accreditation visit.
7. Physical Requirements
Office work at a computer, plus home visits to see patients or supervise staff.
Climbing stairs, kneeling, and helping move a patient up to [50] pounds with help or equipment.
With or without reasonable accommodation.
8. Work Environment and Schedule
Office-based in [branch city], with regular field visits across [your service area].
Regular hours: [Monday through Friday], plus a share of clinical on-call: [your rotation and on-call pay].
Driving between the office and patients' homes, with mileage paid per [your mileage policy].
9. Compensation and Benefits
Pay: [range and hourly or salary basis].
Additional pay: [overtime, bonus or incentive terms, or none].
Benefits: [health, dental, vision, retirement, paid time off, and when they start].
10. Company Culture and Overview
[Two or three sentences on what your company does, the area you serve, and the support a new director of nursing gets in the first 90 days.]
11. How to Apply
[Apply link or email]. Our process: [phone interview, in-person interview, and next steps]. Contact [hiring contact] if you need an accommodation during the application process.
Need help filling this role? HireBus posts the ad, Iris interviews every applicant by phone before you do, and you decide who to hire. Start hiring now
What makes the home health director of nursing job different
A hospital nursing director can walk the unit. This director's staff are spread across several counties, inside patients' homes, and Medicare's home health rules spell out much of what the job oversees.
Saying no to a referral is part of the job
Medicare lets an agency accept a patient only when it can reasonably expect to meet that person's medical, nursing, rehab and social needs at home. The director makes that call. A referral for daily wound care in a county with one nurse, or for a therapy the agency doesn't staff, may need a no. Saying yes and then missing visits is the bigger risk. Source: 42 CFR 484.60: Care planning, coordination of services, and quality of care (Cornell LII).
The first visit runs on a 48-hour clock
A registered nurse has to make the first assessment visit within 48 hours of the referral or of the patient's return home, or on the start date set in the orders. If the orders call only for therapy, a therapist can make that visit instead. So the director matches each new patient to a nurse who can get there in time. On heavy referral days, caseloads get moved around. Source: 42 CFR 484.55: Comprehensive assessment of patients (Cornell LII).
Aide training and testing need an RN
A registered nurse must run each home health aide's skills test. Aide classes and hands-on practice are taught by an RN with at least two years of nursing, one of them in home health, or by others under that nurse's general supervision. If an aide fails a task, they can't do it without an RN watching until they are retrained and pass again. This template puts that program, and the tracking of supervisory visits, with the director. Source: 42 CFR 484.80: Home health aide services (Cornell LII).
Infection control sits inside the quality program
Medicare requires a documented infection control program that follows accepted standards, such as standard precautions. It has to spot, track and look into infections as part of the quality program, with a plan to act on what it finds. Staff, patients and family caregivers all get taught. In home health that means how clinicians carry and clean their gear between houses, and how supplies are kept in the home. Source: 42 CFR 484.70: Infection prevention and control (Cornell LII).
One plan for every discipline on the case
A patient may have a nurse, a physical therapist, a social worker and an aide. Orders may come from a surgeon and a family doctor. Medicare expects the agency to fold all of those orders into one plan and keep every worker on the case, contract staff too, working from it. The director runs the case meetings where that happens. When the nurse and the therapist see a patient differently, the director settles it. Source: 42 CFR 484.60: Care planning, coordination of services, and quality of care (Cornell LII).
How much home health directors of nursing make
The closest BLS group for home health directors of nursing is medical and health services managers. Medical and health services managers who work for home health care agencies earned a median of $101,830 a year ($48.96 an hour) in May 2025, according to the Bureau of Labor Statistics. That’s below the $123,860 median for medical and health services managers in all industries. About 30,360 of the 597,080 medical and health services managers in that survey work for home health care agencies.
Salaried. Say in the offer how clinical on-call weeks are paid, and whether the director is expected to make patient visits when the schedule runs short.
Home health care agencies
$101,830$101,830 median Middle half $85,690–$128,650 10th–90th $73,330–$165,400
All industries
$123,860$123,860 median Middle half $94,700–$166,100 10th–90th $73,390–$224,340
$50k$75k$100k$125k$150k$175k$200k$225k$250k
10th–90th percentileMiddle halfMedianAnnual pay, May 2025. Source: BLS Occupational Employment and Wage Statistics.
Annual pay by percentile
Group
10th
25th
Median
75th
90th
Home health care agencies
$73,330
$85,690
$101,830
$128,650
$165,400
All industries
$73,390
$94,700
$123,860
$166,100
$224,340
Skills to hire for, and what you can teach
Hire for these
Years of home health nursing, so they know what a visit really takes
Reads an OASIS assessment and a plan of care and spots what's weak in minutes
Makes a quick, safe call on a referral the agency may not be able to staff
Coaches nurses on their charting without redoing it for them
Talks plainly with doctors' offices and families when care changes
Keeps aide competency checks and supervisory visits from slipping
Teach these on the job
How your EMR flags overdue assessments, unsigned orders and missed visits
Your referral sources and the kinds of patients each one sends
Your aide competency checklists and in-service calendar
Your on-call phone tree and escalation steps
The towns, roads and drive times across your service area
The director lives in the agency's home health EMR: the referral queue, caseload and visit maps, OASIS review screens and order tracking. In the interview, ask the candidate to show how they would find every patient due for recertification next week and who is assigned to see them.
Home health director of nursing interview questions
They have their own page: 6 questions that test this job, what strong and weak answers sound like, and a work exercise to run with your finalists.
Set each blank in the template from your reports for the past few quarters, then go over them with the director at each monthly quality meeting.
Start of care within required time frames
For each new patient, compare the referral or return-home date with the first assessment visit, and count how many met the federal window or the ordered start date. Pull the late ones each week with their reasons.
OASIS accuracy on review
From the reviewer's log, the share of admission and recert OASIS sets sent back to the clinician for changes. Break it out by nurse and by item, and teach to the items missed most often.
Acute care hospitalization rate
Patients admitted to a hospital while on service, out of all patients served, from your transfer assessments each month. Check it against the quality reports CMS gives you, and talk through each admission at case conference.
Plans of care signed and returned on time
Days from sending each plan of care to getting it back signed, from the order tracking report. List the slowest doctors' offices and call them before the next plan is due.
Clinical staff turnover
Count the nurses, therapists and aides who left this quarter, and divide by the average clinical headcount. Count people who leave in their first months on their own, and ask each one who leaves what would have kept them.
Career path
RN case managerCarries a caseload, opens cases and learns OASIS in the field.
Clinical supervisor or team leadReviews charts and covers on-call for one team or branch.
Director of nursingRuns clinical care for the agency and often serves as its clinical manager.
AdministratorTakes over daily operations of the whole certified agency.
Does a home health director of nursing have to be an RN?
Not under Medicare's rule for the clinical manager. That rule accepts a registered nurse, but also a licensed physician, social worker or audiologist, or a physical, occupational or speech therapist. States can set a higher bar. Texas, for one, requires its home health supervising nurse to be an RN with at least one year of RN experience in the last 36 months. This template requires an RN, since this person also leads the nurses.
How much does a home health director of nursing make?
Medical and health services managers who work for home health care agencies earned a median of $101,830 a year ($48.96 an hour) in May 2025, according to the Bureau of Labor Statistics. The middle half earned between $85,690 and $128,650 a year. Pay also depends on your local market, experience and bonus terms.
How is a director of nursing different from an RN case manager?
The case manager owns a caseload: the visits, assessments, plans of care and teaching for their own patients. The director owns every caseload. They decide who gets which patient, review a sample of the case managers' work, take the hardest clinical calls and train the staff. Many directors carried a caseload first, and in a small branch they may still open a case when no one else can.
Does each branch need its own clinical manager?
The federal rule doesn't set a number per office. It asks for one or more qualified people to oversee all patient care and staff: making patient and staff assignments, coordinating care and referrals, and keeping each plan of care current. The administrator must also make sure a clinical manager is reachable during all operating hours. With two or three offices, write down who covers each one, so a surveyor can see who makes assignments there. Then check your state's licensing rules, which may ask for more.
Can we promote an RN case manager to director of nursing?
Often, if they already know OASIS, the Medicare rules and your EMR. The hard parts are new. They will manage people who used to be their peers, turn down referrals, and keep aide training records ready for a surveyor. Give a new director a mentor, such as your administrator or a director at a sister agency. Then give them time to learn the reports before you add a branch.
