Hospice Case manager, Weekends - Oakland County

Trinity Health•Clarkston, MI

1d•Onsite

About The Position

The Hospice RN Case Manager provides professional nursing care to the organization’s hospice clients as prescribed by the physician, and/or requested by the client/family, and in compliance with the state’s Nurse Practice Act, any applicable licensure/certification requirements, and the organization’s policies and procedures. The RN is fully responsible for the client assessment, care planning, therapeutic intervention, and overall supervision of client care and outcomes, is designated as the case manager for hospice patients. The Hospice RN in collaboration with the physician and other Hospice team members anticipates and manages patient’s symptoms, assists in identifying pt/family/caregiver grief/loss issues and assists in implementing the Hospice plan of care. Provides functional support to Hospice Aides and LPN/LVNs as needed. Trinity Health At Home is shaping the future of healthcare. Our standard, evidence-backed care models and operations are enhancing our colleagues' experience, empowering families, and delivering better care at lower costs. We use the industry's best technology, including: Lightweight tablets Advanced, easy-to-use EMR Messaging and communication tools.

Requirements

Graduate of an approved Nursing education program
Current Registered Nurse licensure in the state of practice.
Must have a minimum of one (1) year experience as a professional acute care nurse.
Exhibits strong communication and interpersonal skills, with a special emphasis on grief/loss management.
Must have current Driver’s license and reliable transportation to and from work site.
Ability to consistently demonstrate commitment to the mission and Organizational Code of Ethics and adhere to the Compliance Program.

Nice To Haves

Home healthcare/hospice experience preferred.

Responsibilities

Informs the client/caregiver about the agency, care/services available, client obligation for payment, and other responsibilities and rights, before care is initiated.
Accurately explains/understands the Hospice Benefit.
Develops and implements an individualized Plan of Care that incorporates realistic, and attainable goals that is also outcome-focused so that the services provided will improve the patient’s quality of life and promote dignity.
Makes appropriate referrals for evaluation/care to other disciplines and services, and coordinates care with others to ensure effective and efficient care is provided.
Utilizes interview, observation, and evaluation in assessing clients and applies nursing judgment, practice standards, in formulating nursing interventions and making recommendations to the physician, client/family and IDT/IDG.
Reports changes in client condition as appropriate and in a timely manner, to the client’s physician and/or Case Manager/designee and obtains orders for changes in the plan of treatment to respond to the client’s condition.
Re-evaluates and updates patient’s plan of care based on patient goals and progress towards outcomes.
Assess patient and family learning styles and needs for teaching regarding disease process, self-care, end of life care, and dealing with ethical concerns as well as patient goals as part of plan of care.
Responds appropriately to changes in patient’s physical, psychological, or spiritual conditions.
Models’ teamwork to accomplish to accomplish organizational goals and provide quality patient care.
Demonstrates respect for cultural diversity in all care delivery and communication with co-workers, patients, and families.
Maintains and enhances knowledge of pain and symptom management in hospice and palliative care patients, utilizing evidence-based protocols and standing guidelines per policy.
Adequately prepares patients and families regarding the expected disease process.
Provides anticipatory education and guidance to patients and families regarding the death and dying process.
Accurately documents observations, interventions and evaluations pertaining to client care management and services in accordance with agency policy and procedure utilizing the point of care information system.
Takes appropriate steps to assure timely submission of client data to the office for inclusion in the client record (by timely electronic transmission of data, or when appropriate by fax or mail).
Documentation reflects progress towards patient/family goals.
Documents all collaborative contact with physicians and other members of IDT/IDG team.
Assures that documentation and orders are up to date and completed in a timely manner.