Registered Nurse (RN) Case Manager - Hospice

ATEX Healthcare Hospice•McAllen, TX

11d

About The Position

Plans, organizes, and directs home care services, applying nursing experience with emphasis on community health education and experience. Builds on community resources to plan and direct services that meet the needs of individuals and families in their homes and communities. Ensures staff and support resources are appropriately utilized and interdisciplinary teamwork is maintained through delegation of duties for Home Health and Hospice. Provides patient care through initial and ongoing assessments, development and implementation of care plans, medication and treatment administration, patient and family counseling and education, and coordination of services. May act as case manager for an assigned caseload when designated by the Clinical Supervisor. Communicates with physicians and community health personnel, provides clinical direction and supervision to aides and LPNs/LVNs, and participates in on-call duties.

Requirements

Current, valid nursing licensure in the state of employment.
One to two years of recent acute-care experience in an institutional setting.
Current, valid CPR certification.
Licensed driver with an automobile insured according to state or company requirements and in good working order.
Comply with acceptable professional standards and practice.
Demonstrate good communication and management skills.
Demonstrate autonomy, organization, assertiveness, flexibility, and cooperation in performing job responsibilities.
Be capable of performing the job functions with or without accommodations.

Nice To Haves

Bachelor’s degree.
One year of home health and/or hospice care experience.

Responsibilities

Complete initial and ongoing OASIS assessments or comprehensive assessments of the effects of terminal disease on patients’ physical, functional, psychosocial, and environmental needs.
Conduct complete physical assessments and obtain histories of current and previous illnesses; regularly reevaluate nursing needs.
Develop, implement, document, and revise plans of care to support quality and continuity of care as patient status and needs change.
Use assessment data to determine nursing diagnoses and establish goals and therapeutic, preventative, and rehabilitative nursing actions.
Include patients and families in care planning and provide counseling, health instructions, and education about disease processes, self-care, end-of-life care, nutrition, and dietary needs as applicable.
Administer medications and treatments as prescribed by the physician and initiate appropriate preventative and rehabilitative nursing procedures.
Prioritize needs with members of the interdisciplinary group/team and provide training to other staff as needed.
Determine the scope and frequency of services based on patient acuity and patient and family needs.
Identify discharge-planning needs and implement plans before discharge.
Act as Case Manager when assigned by the Clinical Supervisor and coordinate care for the assigned caseload.
Prepare clinical notes and update the primary physician when necessary and at least every 60 days.
Communicate patient needs and changes in condition to physicians, obtain or receive physician orders as required, and inform physicians and other personnel of changes and intervention outcomes.
Coordinate the care plan with community health-related personnel.
Participate in on-call duties as defined by the on-call policy.
Ensure arrangements are available for equipment and other necessary items and services.
Provide clinical direction to aides and LPN/LVNs to ensure quality and continuity of service.
Instruct, supervise, and evaluate Home Health and/or Hospice aide care every 14 days.
Adhere to company policies and procedures and perform other duties as assigned.