RN Case Manager | Home Health

Wesley At-Home•Federal Way, WA

About The Position

The RN Case Manager coordinates and manages comprehensive hospice care for patients with terminal illnesses and their families. As the primary clinical leader for an assigned caseload, the RN ensures compassionate, high-quality end-of-life care that supports comfort, dignity, patient goals, and family needs. The position collaborates with physicians, social workers, spiritual care providers, hospice aides, volunteers, therapists, and other interdisciplinary team members to create, implement, and evaluate individualized plans of care in accordance with applicable regulations, hospice Conditions of Participation, and organizational standards. The role covers homes, assisted living communities, adult family homes, and other care settings. The scheduling pattern is seven days on and seven days off, covering 5 p.m. to 8 a.m. on weekdays and all hours on weekends. Availability for weekends and after-hours is required.

Requirements

Graduate of an accredited nursing program.
Active Washington State Registered Nurse (RN) license or out-of-state multistate license (MSL).
Follow the Washington Nurse Practice Act.
If holding an MSL, complete Suicide Prevention Training in advance of hire as required by state regulations.
If holding an MSL, complete the Washington State Board of Nursing (WABON) MSL demographic survey.
Minimum of one year of nursing experience.
Current CPR certification.
Demonstrated assessment, communication, and care coordination skills.
Ability to work independently and collaborate effectively with interdisciplinary teams.
Valid driver's license; driving is an essential function and/or legitimate business purpose of the position.
Strong understanding of hospice and palliative care principles.
Excellent clinical judgment and critical-thinking abilities.
Demonstrated ability to conduct comprehensive patient assessments.
Exceptional interpersonal and communication skills.
Ability to manage multiple priorities and maintain accurate documentation.
Compassionate approach to supporting patients and families during serious illness and end-of-life care.
Ability to maintain confidentiality and exercise discretion.

Nice To Haves

One or more years of hospice, palliative care, home health, oncology, geriatrics, or case management experience.
CHPN (Certified Hospice and Palliative Nurse) certification or willingness to obtain it.
Experience using electronic medical record systems.
Knowledge of Medicare Hospice Conditions of Participation and hospice reimbursement requirements.

Responsibilities

Conduct comprehensive initial and ongoing assessments of patients with terminal illnesses.
Develop, implement, and revise individualized hospice plans of care based on patient goals, disease progression, and symptom management needs.
Identify physical, emotional, psychosocial, spiritual, and environmental factors affecting patient care.
Coordinate physician orders and ensure care is delivered according to established plans of care.
Evaluate patient responses to treatments and interventions and adjust care plans as appropriate.
Manage an assigned caseload of hospice patients across homes, assisted living communities, adult family homes, and other care settings.
Serve as the primary clinical contact for patients, families, physicians, and referral sources.
Coordinate services among the interdisciplinary group to support continuity and effectiveness of care.
Facilitate communication among care team members about patient status, goals, and care plans.
Participate in interdisciplinary team meetings and care conferences.
Assess and manage pain and other distressing symptoms associated with terminal illness.
Provide skilled nursing services, including medication management, wound care, catheter care, infusion therapy, and other hospice-related clinical interventions.
Monitor changes in patient condition and promptly communicate significant findings to physicians and the interdisciplinary team.
Provide timely interventions to maximize comfort and quality of life.
Educate patients and families about disease progression, symptom management, medications, hospice services, and end-of-life expectations.
Provide emotional support and counseling within scope of practice.
Help families understand available community resources and support services.
Support patients and families through care transitions and end-of-life decision-making.
Complete required documentation accurately and within established timeframes.
Maintain compliance with Medicare, Medicaid, accrediting body, and state hospice regulations.
Ensure physician orders, certifications, recertifications, and care plans are current and complete.
Use electronic medical records effectively and protect patient confidentiality in accordance with HIPAA requirements.
Promote quality standards and evidence-based hospice practices and participate in quality and performance improvement activities.
Maintain current clinical competence and knowledge of hospice and palliative care principles.
Participate in surveys, audits, and regulatory reviews as required.
Collaborate with hospice aides, social workers, chaplains, volunteers, therapists, physicians, and other providers.
Provide clinical guidance and direction to hospice aides and other support personnel.
Foster compassion, respect, accountability, and excellence.
Participate in on-call rotations as assigned.
Attend required meetings, training sessions, and continuing education programs.
Perform other duties and special projects as assigned.

Benefits

Medical insurance for full-time and ACA-eligible employees, with family participation if elected.
Dental insurance for full-time employees.
Vision insurance for full-time employees.
Group life insurance with employee-only coverage for full-time employees.
Combined paid time off (PTO) incorporating state paid sick leave and company-paid time off; accrual increases after two and five years of service.
Six paid holidays, with hours based on full-time or part-time status and exclusions for on-call staff.
One personal holiday of choice per year, excluding on-call staff.
403(b) retirement plan with a 100% company match on the first 4% of employee contributions, subject to a five-year vesting schedule and eligibility rules.
On-demand pay through Dayforce Wallet.
Company-paid Employee Assistance Program (EAP).
Wesley Community Foundation grants for qualifying employees' emergency assistance and educational advancement.
50% food and beverage discount at Wesley bistros and marketplaces.
Recognition and rewards platform where earned points can be redeemed for merchandise, gift cards, cash cards, tickets, travel, and other experiences.
Competitive wages and commitment to pay equity.