Registered Nurse (RN) Hospice Case Manager

Lehigh Valley Health Network•Allentown, PA

3d•Onsite

About The Position

The Hospice Case Manager Registered Nurse coordinates and directs care for an assigned caseload of patients receiving services in their homes, working with physicians and the interdisciplinary care team. The role determines the appropriate level of care and skilled service needs in accordance with Conditions of Participation. The nurse initiates, reviews, evaluates, and revises individualized plans of care to support patient goals, quality outcomes, and appropriate transitions in level of care. Responsibilities also include completing initial and ongoing assessments, providing physician-ordered skilled treatments and interventions, and educating patients and caregivers. The position collects required data accurately in accordance with CMS regulations and formulates care plans based on physician orders, assessment findings, and current scientific knowledge. The nurse communicates significant changes in patient status to the physician and care team, coordinates with other network entities, and delivers patient- and family-centered care. Education topics include end-of-life care, palliative care, advance directives, chronic disease management, pain and symptom management, home care, hospice, and discharge planning. The nurse evaluates teaching effectiveness and adapts education to patient needs and goals. This is a full-time, onsite, day-shift position based at 2024 Lehigh Street in Allentown. The schedule is Monday through Friday, 8:00 a.m. to 4:30 p.m., with weekend and holiday rotation. Travel to patient care assignments is required.

Requirements

Specialized diploma from an NLN-approved or accredited nursing program.
One year of recent experience providing direct care in a healthcare setting.
Knowledge of patient education techniques and principles.
Ability to take initiative and function independently without direct supervision.
Ability to participate actively as a member of a care team.
Excellent time-management and organizational skills.
Ability to manage a caseload of patients according to agency standards.
Ability to travel to patient care assignments.
Knowledge of Conditions of Participation.
Knowledge of and skill in completing regulatory data-set collection accurately.
Highly skilled verbal and nonverbal communication.
Ability to facilitate difficult and complex communication related to goals of care.
BLS (Basic Life Support), American Heart Association, within 30 days of hire.
Pennsylvania Registered Nurse license upon hire.
Pennsylvania or New Jersey driver's license upon hire.

Nice To Haves

Associate’s Degree in Nursing or Bachelor’s Degree in Nursing.
One year of experience as a home health or hospice Registered Nurse.
Knowledge of and ability to navigate multiple computer applications and EMR platforms.
Ambulatory Care Nursing Board Certification (AMB-BC), American Nurses Credentialing Center, within three years, or Certified Hospice and Palliative Nurse (CHPN), Hospice and Palliative Nurses Association, within three years.

Responsibilities

Coordinate and direct care for an assigned caseload of patients receiving home-based services in collaboration with the interdisciplinary care team.
Initiate, review, evaluate, and revise plans of care with physicians and the interdisciplinary team to support patient goals, quality metrics, and care transitions.
Collaborate with other network entities to ensure appropriate care delivery and progression.
Complete CMS-regulated data collection accurately to reflect quality outcomes and support appropriate financial reimbursement.
Formulate individualized plans of care based on physician orders, assessment data, and current scientific findings.
Determine appropriate patient care levels and skilled service needs according to Conditions of Participation.
Communicate significant changes in patient status to the physician and other members of the interdisciplinary care team in a timely manner.
Deliver physician-directed care and protocols using a patient- and family-centered approach.
Educate patients, families, and clinical staff on end-of-life issues, palliative care, advance directives, chronic disease management, pain management, symptom control, home care, hospice, and discharge planning.
Promote patient and caregiver autonomy, evaluate the effectiveness of teaching, and modify education according to patient needs and goals.
Travel to patient care assignments.