Hospice RN Nurse Case Manager

About the role

We are seeking a Registered Nurse to serve our patients throughout the [LOCATION] area. The Nurse Case Manager position is a critical part of the patient’s care team. The nurse will visit patients and facilitate with appropriate providers. The nurse will be required to travel to patients' homes, long-term care facilities, etc. to evaluate patients and initiate telemedicine visits. The role requires providing quality healthcare in compliance with all applicable laws, regulations, and policies within the scope of practice.

Responsibilities

• Facilitate receiving all medical records from the patient’s primary provider and specialists.
• Review medical records.
• Complete consents with patients.
• Enroll patients in Care Management, if they meet eligibility criteria.
• Initiate a Care Management Plan of Care, if the patient is eligible.
• Capture all diagnoses at the highest specificity by creating gaps and ensure they are accepted.
• Complete AWV’s to be reviewed by the provider.
• Complete cognitive impairment screenings.
• Complete Social Determinants of Health (SDoH) assessments and/or screenings.
• Complete ACP’s to be reviewed with the patient by the provider.
• Evaluate for home health, hospice, palliative, or consults with Your Health Specialty Division, etc.
• Evaluate for RPM devices, resources, or tools that may improve the patient’s quality of life.
• Communicate and coordinate care.
• Reconcile prescribed and OTC medications, vitamins, supplements, herbal remedies, and other treatments.
• Provide post-discharge education.
• Evaluate for adaptive equipment and DME.
• Evaluate for safe environment.
• Evaluation of acute condition(s) or follow-up from previous visit.
• Appropriately and accurately document and log Care Management activities.
• Work in conjunction with care team to keep the patients Care Management care plans up to date.
• Cookordinate with the patient’s health care team, providers, physical and occupational therapists, home health or hospice representatives and other individuals in the patient’s care plan.
• Facilitate visits with appropriate provider or entity.
• Facilitate a telehealth visit with a provider for coordination of care, when necessary.
• Cookordinate with the patient’s hospice interdisciplinary team and other individuals in the patient's care plan.
• Participate in IDG meetings, when necessary.

Requirements

• Must be a Registered nurse.
• Licence must be in good standing with appropriate board/issuer.
• A minimum of three (3) years clinical experience preferred.
• Experience in community settings preferred.
• Proven ability to effectively communicate and collaborate with interdisciplinary care teams, patients, and caregivers.
• Strong written and verbal skills.
• Basic computer knowledge.
• Ability to manage and demonstrate effective leadership skills.
• Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
• Ability to foster a cooperative work environment.
• Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
• Must be able to work flexible hours and travel between offices, facilities, etc.
• Must be a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order.

Qualifications

• License must be in good standing with appropriate board/issuer.
• A minimum of three (3) years clinical experience preferred.
• Experience in community settings preferred.
• Proven ability to effectively communicate and collaborate with interdisciplinary care teams, patients, and caregivers.
• Strong written and verbal skills.
• Basic computer knowledge.
• Ability to manage and demonstrate effective leadership skills.
• Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
• Ability to foster a cooperative work environment.
• Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
• Must be able to work flexible hours and travel between offices, facilities, etc.
• Must be a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order.

Skills

• Effective communication and collaboration with interdisciplinary care teams, patients, and caregivers.
• Strong written and verbal skills.
• Basic computer knowledge.
• Leadership skills.
• Interpersonal and communication skills.
• Flexible scheduling and travel abilities.
• Driving license with a vehicle in good working order.

Benefits

• Variety of competitive compensation package with bonus opportunities.
• Employer matched 401K.
• Free visit & prescriptive services with HDHP insurance plan.
• Employer matched HSAs.
• Generous PTO package.
• Career development & growth opportunities.
• Vehicle allowance.

Pay

The pay for this role is commensurate with experience.

Schedule

The schedule is an 8-hour shift, Monday through Friday, from 8:00 AM to 5:00 PM. The Pittman Schedule is a 7-on, 7-off rotation with 2 days off every 7 days. The role requires driving and managing travel between offices, facilities, etc.