Hospice RN Case Manager-Field

Partners In Care•Bend, OR

7d•$42 - $61

About The Position

Partners In Care (PIC) is an independent 501(c)(3) nonprofit organization and the largest, oldest provider of home health, palliative care, and hospice services in Central Oregon. Serving Deschutes, Crook, and Jefferson counties, our dedicated team of over 200 employees and 200 volunteers delivers compassionate, patient-centered care across a 10,000-square-mile area. Additionally, Hospice House in Bend, Oregon, is a specialty hospital for inpatient hospice care, creating an oasis of tranquility and comfort for patients and their families. We prioritize excellence, empathy, and collaboration, fostering a culture of kindness, respect, and learning while valuing diversity and the well-being of our employees, volunteers, patients, and families. The Registered Nurse plans, coordinates, implements, evaluates home health and hospice services, and is experienced in nursing, with an emphasis on community health education. The professional nurse builds from the resources of the organization & community to provide services to meet the needs of individuals and families within their homes. The Registered Nurse is responsible for cost efficient and effective patient care with quality outcomes.

Requirements

Graduate of an accredited school of nursing with an unencumbered licensure to practice professional nursing in the State of Oregon.
One to two years of recent medical/surgical care experience in an institutional setting.
Valid CPR Certification.
Current automobile insurance, a valid Oregon driver’s license, and reliable transportation are required for those working in the field.
Ability to pass a reference check, background test, drug screen, and TB test.
Strong communication and interpersonal skills.
Excellent assessment, problem-solving skills, and nursing skills per competency check.
Strong clinical judgment and patient triaging skills are vital; efficient time management with minimal oversight; communication skills (with other care team members, including physicians); positive phone interaction/customer service; and computer skills.
Ability to work independently and collaboratively within an interdisciplinary team.
Compassion, empathy, and dedication to patient care.

Nice To Haves

Ideal candidates will possess 1-2 years of home health or hospice experience.

Responsibilities

Complete an initial comprehensive (if HH includes OASIS) and accurate assessment of patient and family to determine home health needs.
Provide a complete physical assessment and history of previous illness (es) and use the health assessment data to determine appropriate diagnosis and need for other disciplines and resources.
Develop an individualized care plan, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions.
Include the patient and the family in the planning process.
Make necessary revisions to the care plan as patient status and needs change.
Complete and update the ongoing assessments and care plan as patient’s status changes.
Initiate appropriate preventive and rehabilitative nursing procedures and treatments and/or end of life comfort procedure.
Administer medications and treatments as prescribed by the physician.
Ensure that arrangements for equipment and other necessary items and services are available.
Provide health care instructions and education to the patient and or family as appropriate per assessment plan and patients’ caregivers’ ability to learn.
Adapt teaching styles to meet patient’s needs and family’s needs.
Identify discharge-planning needs as part of the initial care plan development and implement prior to discharge of the patient.
Develop, monitor, and update the HCA plan of care as necessary including completion of HCA supervisory visits no later than every 14 days.
The HCA plan of care is complete, accurate, and updated every certification or as patient needs change.
Update the primary physician when necessary and at least every sixty days.
Communicate with the physician regarding the patient’s needs, reports, and changes in the patient’s condition; obtain/receive physician’s orders as required.
Communicate with all members of the healthcare team to promote coordinated, efficient care and document coordination of care with all involved with patient care.
Initial assessments are complete, accurate, and submitted within 48-72 hours of admit.
Additionally, ongoing clinical documentation is complete, accurate, documented, and submitted within 24 hours of patient visit.
Participate in weeknight and weekend on-call duties as defined by the on-call policy.
Local/regional travel by personal vehicle during the working day, centralized from the Bend office and extending throughout Central Oregon.
Complies with all applicable laws, regulations, policies and procedures.
Adheres to the PIC mission and values.
Supports the organization.