RN Case Manager (Plant City Area) LifePath Hospice
About The Position
The RN, Case Manager is responsible for assessing and identifying patient/family needs, utilizing the nursing process, coordinating the Plan of Care with the Interdisciplinary Team (IDT), and providing clinical, palliative and supportive care to the patient/family unit in order to keep the participant in their home environment as long as possible. This role involves providing reassurance on the phone to patients and families, assisting in finding solutions to their questions, and recognizing the need for an in-person visit. The Case Manager coordinates in-person visits when needed or requested, utilizes appropriate support/expert resources to resolve complex situations, and documents patient/family contact information in the EMR. They complete initial and semi-annual assessments, explain services, and address questions regarding patient needs, fears, and physical limitations with empathy and compassion. The role also involves providing information to Physicians and other IDT members, initiating the Plan of Care, and performing skilled nursing interventions to enhance prevention, prevent complications, alleviate symptoms, and maximize comfort. The RN Case Manager obtains Physician orders, completes documentation per Company policy, and acts as the Company representative at assigned facilities, facilitating referrals and working closely with referring entities. They communicate frequently with the IDT using SBAR, discuss potential needs with after-hours staff, and develop strong relationships with case managers and physicians at facilities.
Requirements
- Current license as RN in the state where the employee will be working
- Minimum of one (1) year nursing experience; hospice or hospital experience preferred
- Employees working at PACE, certification of completion of Alzheimer's Disease and Related Dementias Training through the Florida Department of Elder Affairs
- Previous experience working with an EMR/EHR (Electronic Medical/Health Record) system
- Mobile Driver - Valid driver’s license and automobile insurance per Company policy
- Reliable transportation to meet visit schedule
- Ability to use equipment with visual and auditory mechanisms
- Ability to effectively communicate in English (verbal and written)
- Ability to visit Participant in their homes to assessments
- Ability to perform the essential functions and physical requirements (including, but not limited to: lifting patients and/or equipment, bending, pushing/pulling, kneeling) of the job with or without reasonable accommodation
- Active BLS for healthcare professionals from the American Heart Association or Red Cross.
Nice To Haves
- hospice or hospital experience preferred
Responsibilities
- Provides and manages direct care to patients and families as part of Interdisciplinary Team (IDT), incorporating psychosocial, spiritual, cultural, physical and biological components, and appropriate nursing intervention and follow-up.
- Coordinates the Plan of Care, ensuring that an individualized Plan of Care is developed that accurately reflects the patient’s evolving needs.
- Educates patient, family, caregivers and other health professionals about disease process and decline, prevention, palliative interventions, care giving, dying process and safety practices.
- Home visits to assess home safety, medication compliance, nutritional compliance, DME compliance- ability to live safely in the community.
- Reports changes in the patient’s condition to appropriate members of the IDT or other health professionals.
- Participates with the IDT to evaluate hospice referrals/admissions for level of care appropriateness.
- Attends daily IDT collaboration meetings.
- Presents concise and pertinent oral and written reports to IDT; respects and encourages input from all disciplines.
- Communicates accurately and completely to physicians, staff members, patients, families, and supervisors; utilizes positive approaches when working with others.
- Supervises patient care provided by Community Health Workers and Home Health Aides as requested.
- During times of emergencies (i.e. Hurricanes, etc.), the RN, Case Manager may be required to report to work at a location designated by the company, to ensure continuity of services. This may include reporting to work ahead of your scheduled date/time due to planned lock down of unit, and staying overnight(s) based on duration of emergency.
- Performs other duties as assigned.
- Represent the Company professionally at all times through care delivered and/or services provided to all clients.
- Comply with all State, federal and local government regulations, maintaining a strong position against fraud and abuse.
- Comply with Company policies, procedures and standard practices.
- Observe the Company's health, safety and security practices.
- Maintain the confidentiality of patients, families, colleagues and other sensitive situations within the Company.
- Use resources in a fiscally responsible manner.
- Promote the Company through participation in community and professional organizations.
- Participate proactively in improving performance at the organizational, departmental and individual levels.
- Improve own professional knowledge and skill level.
- Advance electronic media skills.
- Support Company research and educational activities.
- Share expertise with co-workers both formally and informally.
- Participate in Quality Assessment and Performance Improvement activities as appropriate for the position.
Benefits
- Sign-on bonus Available
- Benefits begin Day 1
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
