Registered Nurse Case Manager, Hospice

Job Description

The Registered Nurse Case Manager (RN CM) at VNA Health plans, organizes, and directs hospice services. They are experienced in nursing, focusing on community health education and experience. The RN CM builds from community resources to plan and direct services to meet the needs of individual and family patients in their homes and communities. They respect and promote VNA Health's mission, values, and vision.

Job Duties

• Patient Care
• Provides comprehensive case management to hospice patients.
• Completes an initial assessment of patient and family to determine hospice care needs.
• Completes a complete physical assessment and history of current and previous illnesses.
• Admits patients to appropriate levels of service/care.
• Affirms and evaluates patients' statuses by writing and initiating a plan of care.
• Regularly re-evaluates patient and family/caregiver needs and revises the plan of care as necessary.
• Uses health assessment data to determine nursing diagnoses.
• Develops a plan of care pathway that establishes goals based on nursing diagnoses and incorporates palliative nursing actions.
• Involves the patient and family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures.
• Administers medications and treatments as prescribed by the physician in the physician’s plan of care.
• Counsels the patient and family in meeting nursing and related needs.
• Provides health care instructions to the patient as appropriate per assessment and plan.
• Assists the patient with the activities of daily living and facilitates the patient's efforts towards self-sufficiency and optional comfort care.
• Communication
• Completes, maintains, and submits accurate and relevant clinical notes regarding patient's condition.
• Records pain/symptom management changes/outcomes as appropriate.
• Communicates with the physician regarding the patient's needs and reports any changes in the patient's condition; obtains/receives physicians orders as required.
• Communicates with community health-related persons to coordinate the care plan.
• Teaches the patient and family/caregiver self-care techniques as appropriate.
• Provides medication, diet, and other instructions as ordered by the physician and recognizes and utilizes opportunities for health counseling with patients and families/caregivers.
• Works in concert with the hospice Interdisciplinary Team Members.
• Provides and maintains a safe environment for the patient.
• Assists the patient and family/caregiver and other team members in providing continuity of care.
• Works in cooperation with the family/caregiver and hospice Interdisciplinary Team Members to meet the emotional needs of the patient and family/caregiver.

Qualifications

• Current and active California RN license.
• Bachelor’s degree, preferred.
• Minimum one year acute care experience required.
• One year recent hospice experience preferred.
• Current CPR certification.
• Licensed driver with insured automobile - in accordance with state and/or organization requirements.
• Management experience not required.
• Responsible for supervising hospice home health aides/LVNs.
• Excellent observation, verbal and written communication skills, problem-solving skills, basic math skills; nursing skills per competency checklist.
• Ability to respond independently to life-threatening situations.
• Ability to reason, deduce, and carry out complex multiple-step processes.
• Bilingual – Spanish preferred, but not necessary.

Physical Requirements

• Ability to lift 25 lbs.
• Ability to push/pull 50 lbs.
• Ability to stoop, bend, and squat.
• Ability to walk up one flight of stairs.
• Ability to walk one mile.
• Ability to sit for one hour, minimum.
• Visual and audio acuity.