RN Case Manager
At Grace Hospice, our mission is for each employee to treat every patient as their own treasured loved one, providing care that affords a quality of life that outweighs quantity of days, and supports caregivers as their hearts find healing.
Our program ensures that our patients will spend the final days of their journey in comfort and with dignity. If you are caring, compassionate, and have a true desire to help others, becoming a member of the Grace Hospice team may be the perfect opportunity for you.
Some of the benefits and advantages of working with Grace Hospice Include:
- Grace Hospice is CHAP accredited and we are Members of the National Hospice and Palliative Care Organization.
- We invest in our employees' career development and growth.
- Comprehensive orientation programs for new hires
- Leadership Academy meetings held off-site regularly for continuous development of our site leadership team members (Office Manager, CS, DCS, and Administrator).
- Grace offers advancement opportunities.
- Grace Hospice has 27 locations across the U.S. and we are growing! This growth creates additional advancement opportunities for strong performers.
- We provide an innovative healthcare environment offering a clinical ladder.
- Grace is founded firmly on five pillars of excellence: People, Service, Quality, Finance, and Growth.
- Our environment offers collaboration and provides tools and programs to enhance our team's ability to provide excellent care.
- Our point-of-care system is state of the art: HomeCare HomeBase.
- Employees have access to referring physicians and other professional resources on a daily basis.
- Inter-disciplinary Team conferences are held regularly to discuss and optimize patient care.
- Our 'Meaningful Memories' program is in development to provide exceptional patient experiences.
Under the general supervision of the Administrator, the RN Case Manager provides intermittent skilled nursing services; communicates the patient's progress with other disciplines and directs, supervises and instructs nonprofessional hospice aide staff in the provision of personal care to the patient. ESSENTIAL DUTIES AND RESPONSIBILITIES
REQUIRED KNOWLEDGE, SKILLS, AND EXPERIENCE
- Under the physician's order, admits patients eligible for hospice services.
- Assess and evaluates patient needs/problems, identifies mutually agreed upon goals with patients.
- Reports patient status and need for other disciplines to agency intake coordinator, RN Manager, and referring Physician.
- Develops patient care plan that specifically addresses identified patient problems; nursing problems and goals. Updates care plans on an ongoing basis; revises and resolves patient problems and goals as changes occur and/or recertification.
- Admit paperwork and patient care plan submitted to RN Manager within 2 days following the admit.
- Assures that all admit paperwork is completed in full at time of submission for timely data entry of IDG/POC information.
- Provides intermittent Skilled Nursing services including assessment, evaluation, procedures, teaching and training activities as outlined in the patient IDG Plan of Care.
- Provides Skilled Nursing visits according to visit schedule and notifies agency of need to alter schedule in any way.
- Reports significant findings to patient's Physician and RN Manager as they occur.
- Submits completed skilled nursing notes; communication notes and hospice aide supervisory notes per policy.
- Submits change orders within 48 hours of occurrence.
- Submits recertification paperwork by the due date provided by the RN Manager.
- Schedules an IDT meeting with assigned RN Manager to review patient's needs, problems, level of care and any changes in Plan of Care for next cert period.
- Completes communication note documenting plans for recertification were discussed and agreed upon between the physician, patient, and RN Manager.
- Completes other required documents for recertification: new Medication Profile, updates Care Plan, and updates or completes new Hospice Aide Plan of Care, if applicable.
- Performs hospice aide supervisory visits (and completes documentation for supervisory notes)
- Effectively communicates with all members of the healthcare team.
- Acts as the patient's advocate, and, as such, is a liaison to assist in communicating the patient's needs to the multidisciplinary team.
- Reports identified performance related problems; patient complaints and/or deviation from the Hospice Aide instruction sheet to the RN Manager.
- Acts as a preceptor in the orientation of new nursing staff.
- Attends staff meetings and educational in-services per agency requirements.
- Continually strives to improve nursing care by broadening knowledge through formal education, attendance at workshops, conferences and participation in professional and related organizations and individual research reading.
- Obtains CEU's as dictated by the State Board of Nurses.
- Attends at least 50% of the skilled nurse in-services and meetings provided by agency.
- Is responsible for obtaining information provided at skilled nurse in-services and meetings and demonstrates appropriate follow-up related to information given at meetings and in-services.
- Participates in PI program through submission of data collection as it relates to direct patient care problems and serving on PI teams.
- Follows agency policies and procedures.
- Participates in discharge planning process.
- Documents Discharge Planning beginning with admit and documents at least 2 weeks in advance instructions given related to discharge.
- Completes the Patient Care Plan and Discharge Nurse's Noted and submits them along with other notes turned in per agency policy.
PREFERRED KNOWLEDGE, SKILLS, AND EXPERIENCE
- Is currently a Registered Nurse in the state of practice or in accordance with the Board of Nurse Examiners rules for Nurse Licensure Compact (NLC)
- Ability to work in a field setting and exhibited ability to make sound nursing judgments
- Ability to assess patient needs and formulate individualized patient care plans to meet those needs.
- Effective communication skills
- Must have and maintain an automobile to be used for work.
- One year experience as a professional nurse preferred