RN, Case Manager - Float Team (HPH Hospice)

Chapters Health•Brooksville, FL

About The Position

The RN, Case Manager on the HPH Hospice Float Team assesses and identifies patient and family needs, uses the nursing process, coordinates the Plan of Care with the Interdisciplinary Team (IDT), and provides clinical, palliative, and supportive care to help patients remain in their home environment as long as possible. The role includes patient and family contact, home visits, clinical assessment, care coordination, education, documentation, and collaboration with physicians, facilities, and other IDT members. The schedule is four 10-hour shifts, including every weekend and two weekdays, plus one summer and one winter holiday. During emergencies, such as hurricanes, the nurse may need to report to a company-designated location before a scheduled shift and may need to stay overnight to ensure continuity of services. The position requires a current RN license in the state of employment, BLS certification, a valid driver’s license and automobile insurance, reliable transportation, and the ability to perform the role’s essential functions with or without reasonable accommodation. Compensation is $61,860.66–$96,657.28. Employment is contingent on drug and/or alcohol testing after a conditional offer and ongoing compliance with the Drug-Free Workplace Policy. Employees serving Florida affiliates are subject to background screening and ongoing eligibility verification through the Florida Care Provider Background Screening Clearinghouse.

Requirements

Current RN license in the state where the employee will be working.
At least one year of nursing experience; hospice or hospital experience is preferred.
Previous experience using an EMR/EHR system.
Valid driver’s license and automobile insurance in accordance with Company policy; reliable transportation to meet the visit schedule.
Ability to use equipment with visual and auditory mechanisms.
Ability to communicate effectively in English, verbally and in writing.
Ability to visit participants in their homes for assessments.
Ability to perform essential job functions and physical requirements, with or without reasonable accommodation.
Active BLS certification for healthcare professionals from the American Heart Association or American Red Cross.
Satisfactory completion of competency requirements for the position.
For employees working at PACE: completion certification for Alzheimer’s Disease and Related Dementias Training through the Florida Department of Elder Affairs.

Nice To Haves

Hospice or hospital nursing experience.

Responsibilities

Provide and manage direct care to patients and families as part of the IDT, incorporating psychosocial, spiritual, cultural, physical, and biological considerations and appropriate nursing interventions and follow-up.
Coordinate an individualized Plan of Care that reflects the patient’s changing needs.
Educate patients, families, caregivers, and health professionals about disease progression, prevention, palliative interventions, caregiving, the dying process, and safety practices.
Conduct home visits to assess home safety, medication and nutritional compliance, durable medical equipment compliance, and the patient’s ability to live safely in the community; visit frequency depends on risk score and needs.
Report changes in patient condition to appropriate IDT members or other health professionals.
Participate with the IDT in evaluating hospice referrals and admissions for appropriate level of care; attend daily IDT collaboration meetings.
Present concise, relevant oral and written reports to the IDT and encourage input from all disciplines.
Communicate accurately and completely with physicians, staff, patients, families, and supervisors, using positive approaches when working with others.
Supervise patient care provided by Community Health Workers and Home Health Aides when requested.
Provide reassurance by phone to patients and families, help resolve questions, determine when an in-person visit is needed, coordinate visits, use appropriate support resources for complex situations, document contacts in the EMR, and communicate with the IDT, where applicable.
Complete initial and semiannual assessments for Company services; explain services, address patient and family concerns, provide information to physicians and IDT members, initiate a Plan of Care for immediate needs, perform skilled nursing interventions, obtain physician orders, and document according to Company policy.
Represent the Company at assigned facilities and facilitate referrals to service lines while working with referring hospitals, physicians, facilities, patients, families, and the public.
Communicate clinical information promptly using SBAR, discuss potential needs with after-hours staff, and develop relationships with facility case managers and physicians.
Represent the Company professionally; comply with applicable regulations and Company policies; maintain confidentiality; follow health, safety, and security practices; and use resources responsibly.
Participate in community and professional organizations, performance improvement, professional learning, electronic media skill development, research and educational activities, knowledge-sharing, and Quality Assessment and Performance Improvement activities as appropriate.
Report to a company-designated location during emergencies as required to maintain continuity of services; perform other duties as assigned.