RN Case Manager Hospice - PD

 SUMMARY:                               

Coordinates/manages a case load comprised of Hospice patients.  Assesses, plans, implements, coordinates, and evaluates care for each patient/family in conjunction with the hospice interdisciplinary team.  Case management includes but is not limited to; comprehensive needs assessments, development of appropriate plan of care, referral to internal and external resources, evaluation of outcomes, and provision of nursing educational, clinical and related services.  Supervises the Licensed Nursing Assistants/ Home Health Aides. 

RESPONSIBILITIES:

Provides a full range of professional nursing care to patients in their homes under the medical direction of a licensed physician.

• Makes nursing evaluation visits in patient's home.


• Regularly reevaluates patient's nursing needs and informs physician and other personnel of any changes in patient's condition or needs.


• Initiates the plan of treatment and any necessary revisions.


• Provides those services requiring specialized nursing skills.


• Initiates appropriate comfort focused nursing procedures.


• Maintains accurate, up-to-date records of patients and care given.

Supervises and schedules the Home Health Aides.  Teaches nursing care to be given in the home and reviews and explains the patient care plans.

Performs initial and subsequent assessments of patient/family physical, emotional, psychosocial, spiritual and cultural needs to ensure and coordinate the delivery of comprehensive, comfort-focused services through the development of the Hospice patient plan of care.

Documents all patient/family interactions in the medical record per agency policies/protocols.

Represents VNAH in a positive, proactive manner while participating in community education/support/ PR events.

Maintains continuity of patient care by planning and exchanging information with IDT members, Department personnel and other health and social agencies as is appropriate.

Recommends changes in agency policies or services in order to improve patient care techniques or programs.

Continues professional development by participating in continuing education programs, conferences, and workshops.

Understands and applies Medicare Hospice Conditions of Participation to practice situations.

Incorporates infection control protocols with professional practice.

Participates in the Agency’s continuous quality improvement activities.

Meets Agency's productivity expectations, census permitting.

COVERAGE:

• Nights- All Hospice nurses will participate in the night shift rotation with all Traveler nurses to ensure we have adequate staffing coverage.


• Weekends – All Hospice nurses will be on a rotating weekend schedule to ensure we have adequate staffing coverage.


• Holidays – All Hospice nurses will be on a rotating holiday schedule to ensure we have adequate staffing coverage.

QUALIFICATIONS:                                           

Education:          

Graduate of an NLN accredited school of nursing. Baccalaureate Degree preferred. 

Holds or is eligible for RN license in the States of Vermont/New Hampshire (required). 

Certified in Hospice/Palliative Care Nursing desirable.

Experience:       

Minimum two years’ general experience in a supervised nursing setting recommended.  Hospice/Homecare experience preferred.

Skills/Abilities:  

• Ability to work well independently and as a member of a team.


• Able to communicate well both verbally and in writing.


• Ability to be flexible with regard to workload and assignments.


• Strong organizational and interpersonal skills.


• Ability to maintain highest levels of confidentiality.


• Strong computer skill and knowledge.


• Must meet essential requirements for direct service staff.

PER DIEM

Hospice RN Per Diem:

Minimum qualifications: In addition to those for a hospice RN

• 1-year previous practice in home based hospice, including phone triage with patients

Role description:

A Per diem RN in hospice may be utilized to perform the following patient visits:

• routine visits according the Plan of Care (in person or remotely)


• initial visits for symptom control


• on call visits


• over night shifts


• death visits


• full admission visits


• continuous care

Per diem RNs in hospice will not be a case manager or responsible for LNA supervision.

Work hours:

Per diem hospice RNs will be available to work a minimum of:

• 1 shift a month


• At least once a quarter, 1 shift must be either a weekend or night shift


• 1 holiday a year