RN Case Manager - PRN

Heart N Soul Hospice•Nashville, TN

1d•Onsite

About The Position

The primary functions of this role are to administer skilled nursing care for clients of all ages in their place of residence, coordinate care with the interdisciplinary team, patient/family, and referring agency, and to assume responsibility for care coordination. This position requires a strong understanding of nursing skills, critical thinking, and the ability to work autonomously and as part of a team. The role involves implementing individualized care plans, collaborating with physicians and healthcare professionals, and educating patients and families about disease processes and end-of-life care. The RN Case Manager will also perform on-call responsibilities and ensure timely submission of all documentation in compliance with regulations.

Requirements

Graduate of an accredited Diploma, Associate or Baccalaureate School of Nursing
Current State license as a Registered Nurse
Current State Drivers License
Two years of experience as an RN preferred in a healthcare/clinical setting
Nursing skills as defined as generally accepted standards of practice
Strong critical thinking, organizational, interpersonal, and communication skills
Must be highly motivated, self-directed, flexible, and able to work well and participate in a multidisciplinary group setting
Ability to work autonomously
Flexible schedule for late afternoon admits
Must meet mandatory CE requirements of licensing board per state and maintain a current status
Must read, write and comprehend English
Must have reliable transportation and provide ongoing valid and current auto liability insurance

Nice To Haves

Experience in EMR a plus
Specialized skills preferred in palliation and end-of-life
Proof of current CPR and maintain a current status

Responsibilities

Administer skilled nursing care for clients of all ages in their place of residence.
Coordinate care with the interdisciplinary team, patient/family, and referring agency.
Implement the individualized POC and recommend revisions to the plan as necessary.
Collaborate care amongst patient/patient caregiver, physicians, and healthcare professionals.
Consult with and educate the patient and family regarding disease process, self-care techniques, end-of-life care, nutrition and dietary needs.
Provide training to other staff as needed.
Prepare clinical and progress notes that demonstrate progress toward established goals.
Attend Inter-Disciplinary Group (IDG) meeting, coordinate and participate in the patient care planning process, prioritization of needs and collaborates with IDG to promote coordination of patient care.
Use of case management approach and referring to other services as needed.
Inform physician and other personnel of changes in the patient’s needs and outcomes of intervention, while evaluating patient/family response to care.
Determine scope and frequency of services needed based on acuity and patient/family needs.
Assess ability of the caregiver to meet the patient’s immediate needs upon admission and throughout care.
Evaluate own needs for support and using identified systems to meet the need.
Communicate information using current process and technology available to the organization.
Apply specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient’s eligibility.
Perform on-call responsibilities and provide on-call service to patients/families as assigned.
Supervisor of LPN/LVN and Hospice Aide per regulations.
In EMR/HCHB, all visits are to be completed and synced same day.
Utilize excellent customer care skills with internal and external customers, including using proper phone etiquette.
Promote positive, respectful communication to all staff, referral sources, patients and families.
Abide by and demonstrate the company Mission and 12 Heart’s Desires through both behavior and job performance on a day-to-day basis.
Performance of other duties as required.
Participate in all mandatory staff in-services and meetings.
Maintain compliance with internal annual education requirements (Heart to Heart University/Relias).
Timely submission of all documentation.
Conduct all business activities in a professional and ethical manner.
Ensure overall compliance with local, state and federal laws, Medicare regulations, and established personnel policies and procedures.