The Registered Nurse Case Manager is responsible for modeling the 3 Company values of Compassion, Integrity, and Excellence, and for promoting the Hospice Compassus philosophy, using the 6 Pillars of success as the foundation. S/he is responsible for upholding the Code of Ethical Conduct and for promoting positive working relationships within the Program, between the Program and other Company departments, and between the Program and all external stakeholders. The Registered Nurse Case Manager functions as an IDT member to provide routine and emergency assessment, (including on-call responsibilities), educational, and evaluative services to meet the needs of patients and their families. S/he helps the patient and family maintain their maximum level of comfort and coping. He/she flexes schedule to meet agency-staffing needs and provides after hours emergency support to the patient and family. S/he is responsible for applying the rules and regulations of state and federal regulatory agencies and other certified agencies.
Supports agency and corporate policies, goals, and objectives.
Promotes a positive working relationship between agency and corporate personnel.
Attends and participates in staff meetings, educational programs and community events, as requested.
Promotes hospice philosophy.
Communicates identified needs and potential solutions to supervisor.
Performs routine and emergency assessments.
Completes routine and emergency assessments on each patient as indicated by departmental policy.
Coordinates clinical and psycho-social and spiritual services as indicated by Plan of Care through case management.
Records observations, treatments, and other pertinent information.
Communicates with IDT, Medical Director and Attending Physician as directed regarding measures to alleviate symptoms, and monitors response to measures implemented.
Provides physical and emotional interventive care to support the patient and family in period of crisis through case management with the psycho-social team.
Prevents unwarranted hospitalizations by meeting patient and family needs in the home.
Coordinates Case Management of routine and emergency patient care.
Collaborates with IDT meet needs of patient for clinical and psycho-social interventions.
Collaborates with IDT to coordinate hospice care for the patient and family to ensure appropriateness, continuity, and quality of care.
Updates the POC for IDT.
Develops and updates care plans following each POC change and ensures updates are made from the psycho-social staff.
Assists in identifying the need for intervention of other IDT members.
Effectively communicates patient and family needs to IDT.
Educates patient and caregiver regarding:
Care of patient.
Explains hospice services and Medicare benefits to patients and families
Obtains the Election of Benefits.
Completes referral and admission assessments as requested.
Maintains appropriate communication.
Keeps physician and Medical Director informed of patient needs and condition.
Ensures documentation at bedside.
Notifies other IDT members of physician concerns and suggestions.
Submits appropriate documentation and paper work to contracted facilities at completion of patient visit.
Completes and submits IDT Narratives, time logs, and all required documentation by 10 A.M. the following morning.
Supervises the care given by Licensed Practical Nurses and Hospices Aides.
Performs other duties as assigned.
KNOWLEDGE AND SKILLS To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Education and/or Experience
Registered Nurse with a current nursing license in state of employment. Minimum one year nursing practice or equivalent experience preferred. Hospice, Oncology, or Home Health and/or long-term care preferred.