Hospice Nurse Practitioner/Nurse Practitioner Case Manager

CONSTELLATION HEALTH SERVICES•Norwalk, CT

4h•$45 - $45

About The Position

The Nurse Practitioner will provide consultation in hospice or palliative care, symptom management and supportive care to meet patient needs in collaboration with referring physician, attending physician, hospice physician and the interdisciplinary care planning team of both continuums.

Requirements

Graduate of an accredited NP program.
The employee has the required licensure, education, training, and qualifications required by rule, regulation, law and/or statute to qualify for the role in their state.
Must possess basic computer skills, excellent documentation, and customer services skills.
Knowledgeable regarding end-of-life care and death and dying process.
Master’s degree, post-master’s certificate, or a doctoral degree in nursing from a university accredited by the Commission on Collegiate Nursing Education (CCNE) or by the National League for Nursing Accrediting Commission (NLNAC).
Employee has the required licensure, education, training and qualifications required by rule, regulation, law and/or statute to qualify for the role in the state the hospice program operates.
Prescriptive abilities to the full scope of licensure within state in which the licensure is held (DEA).
Current National Board Certification from ANCC or AANP as a Clinical Nurse Specialist (CNS) or Nurse Practitioner (NP).

Nice To Haves

Previous home care/hospice preferred but not required.
Experience in hospice or palliative care, clinical oncology, geriatrics, intensive care or community and family health preferred.
Palliative care certification (NBCHPN) or hospice certification (ACHPN®) preferred.
Full participation in and completion of initial credentialing must be accomplished; additionally, subsequent re-credentialing will be accomplished every two years.

Responsibilities

Assist with diagnosis, treatment, and management of patients with advanced disease.
Educate facility staff, co-workers, and the community on the benefits to patients and families to all aspects of hospice care and palliative care services and the services provided by the organization.
Attend and participate in internal interdisciplinary care plan meetings for both continuums of hospice and palliative services.
Consult with referring physician, interdisciplinary care team and other involved providers to contribute to the patient’s plan of care.
Initiates and or participates in advanced care planning | directives as indicated by need of the patient’s clinical disposition.
Facilitate the recommendation of and education to the patient and family as it relates to the appropriate continuum based on the patient’s stage in the disease process(s) and the prognosis trajectory.
Facilitate access utilizing full scope of licensure to the appropriate support models of care through the resources provided within the organization and the community.
Provide anticipatory guidance that allows patients to remain safely in their environment through a proactive plan of care that supports their disease trajectory and changes in comfort.
Prepare and maintain accurate patient records, charts, and documents to support both the hospice and palliative practices along with reimbursement for services provided.
Order diagnostics/treatments as needed and prescribe medications including controlled substances, to the extent delegated and licensed in collaboration with hospice and referring physicians. Interpret, evaluate, and communicate diagnostic findings to the appropriate parties.
Assist in development of clinical practice guidelines and standards in support of quality hospice and palliative care as requested by supervisor.
Responsible to meet or achieve industry benchmarks for appropriate patient disposition and levels of care.
Maintains and processes all documentation in compliance with agency standards.
Will utilize iPad-based documentation system and submit all required clinical documentation, time records and other required information in required time frame.
Demonstrates knowledge of State and Federal Regs and standards and provides care within these guidelines.
Demonstrates sensitivity to cultural and religious differences. Provides support to patient and family members to assist them with barriers to care.
Participates in agency quality improvement activities and action plans.
Provides skilled nursing care including administration of medications and treatments as prescribed in provider’s plan of care for patients in their home setting.
Coordinates plan of care with all disciplines associated with patient’s needs, including family and primary care givers.
Observes, evaluates, and reports on the patient’s physical and emotional status to the team and attending provider if she/he is not acting as the provider whenever change occurs or at least every 60 days.
For Hospice, performs a Comprehensive Assessment of the patient and updates care plan, coordinating with the attending provider (if he/she is not acting in that capacity) & Medical Director along with members of the IDT whenever changes occur or at least every 14 days.
For Hospice, participates in weekly/bi-weekly Interdisciplinary Team Meetings, providing updates on patient’s physical, emotional, psychosocial, and spiritual status.
Attend all required staff meetings to enhance professional development.
Instructs, orients, and supervises other clinical personnel as necessary.
Develop plan of care with instruction for home health aide services.
Provides input to Home Health Aide Supervisor as needed for purpose of home health/hospice aide evaluation.
Provides a comprehensive assessment of patients including patient’s strengths, goals, measurable outcomes and care preferences.
Initial assessment and visit must be completed within 24 hours or by physician’s orders for start of care.
Reviews chart and/or conferences as needed prior to visit.
Documents progress towards achievement of goals.
Performs as dictated by the plan of care and certification period, the face to face encounters to ensure compliance and continued eligibility
Provides written information to patient that includes schedule and frequency of HHA and contract staff, medication schedule, dosing frequencies and meds administrated by staff, treatments, and other pertinent information.
Provides patient with name and contact information of the Agency’s Leadership.
Observes, evaluates, and reports on the patient’s physical and emotional status to nursing supervisor and the attending physician whenever change occurs or at least every 60 days.
Reports any home health aide issue to Clinical Supervisor for follow up.
Ensures that patient records include current emergency plan in accordance with state regs.
Understands and implements the Patient Bill of Rights and company process for patient complaints.
May act as a liaison with institutions to promote continuity of care as the patient moves from level of care to another.
May participate in community activities as a representative of the agency.
Participates in weekend/holiday rotation and on call rotation as needed.
Will perform other duties as assigned.