RN Case Manager

Job Title/Position: Registered Nurse

Reports To: Clinical Supervisor

JOB DESCRIPTION SUMMAR

The registered nurse plans, organizes and directs hospice care and is experienced in nursing,with emphasis on community health education/experience. The professional nurse builds fromthe resources of the community to plan and direct services to meet the needs of individual andfamilies within their homes and communities.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Patient Care

1. Completes an initial, comprehensive and ongoing comprehensive assessment of patientand family to determine hospice needs. Provides a complete physical assessment andhistory of current and previous illness(es).

2. Provides professional nursing care by utilizing all elements of nursing process.

3. Assesses and evaluates patient’s status by:

A. Writing and initiating plan of care

B. Regularly re-evaluating patient and family/caregiver needs

C. Participating in revising the plan of care as necessary

4. Initiates the plan of care and makes necessary revisions as patient status and needschange

5. Uses health assessment data to determine nursing diagnosis

6. Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process.

7. Initiates appropriate preventive and rehabilitative nursing procedures. Administersmedications and treatments as prescribed by the physician in the physician’s plan of care.

8. Counsels the patient and family in meeting nursing and related needs.

Administers medicationsDevelop a care plan that establishes goals based on nursing diagnosis and incorporates palliative nursing actions. Include9. Provides health care instructions to the patient as appropriate per assessment and plan.

10. Assists the patient with the activities of daily living and facilitates the patient’s efforts towardself-sufficiency and optional comfort care.

11. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility tocoordinate patient care for assigned caseload.Capital Hospice and Palliative Care LLCCHAP Hospice Human Resources/Revised November 2020©Corridor 2003222

Communication

1. Completes, maintains and submits accurate and relevant clinical notes regarding patient’scondition and care given. Records pain/symptom management changes/outcomes asappropriate.2. Communicates with the physician regarding the patient’s needs and reports changes in thepatient’s condition; obtains/receives physicians’ orders as required.3. Communicates with community health related persons to coordinate the care plan.4. Teaches the patient and family/caregiver self-care techniques as appropriate. Providesmedication, diet and other instructions as ordered by the physician and recognizes andutilizes opportunities for health counseling with patients and families/caregivers. Works inconcert with the interdisciplinary group.5. Provides and maintains a safe environment for the patient.6. Assists the patient and family/caregiver and other team members in providing continuity ofcare.7. Works in cooperation with the family/caregiver and hospice interdisciplinary group to meetthe emotional needs of the patient and family/caregiver.8. Attends interdisciplinary group meetings.Additional Duties1. Participates in on-call duties as defined by the on-call policy.2. Ensures that arrangements for equipment and other necessary items and servicesare available.3. Supervises ancillary personnel and delegates responsibilities when required.4. Assumes responsibility for personal growth and development and maintains and upgradesprofessional knowledge and practice skills through attendance and participation incontinuing education and inservice classes.5. Fulfills the obligation of requested and/or accepted case assignments.6. Actively participates in quality assessment performance improvement teams and activities.POSITION QUALIFICATIONS1. Graduate of an accredited school of nursing. One (1) to two (2) years of recent acute careexperience in an institutional setting, and one (1) to two (2) years of recent experience inhome care.2. Current licensure in State and CPR certification.Capital Hospice and Palliative Care LLCCHAP Hospice Human Resources/Revised November 2020©Corridor 20032233. Bachelor’s degree, with one (1) year of hospice care experience preferred.4. Management experience not required. Responsible for supervising hospice aides.5. Excellent observation, verbal and written communication skills, problem solving skills, basicmath skills; nursing skills per competency checklist.6. Prolonged or considerable walking or standing. Able to lift, position and/or transferpatients. Able to lift supplies and equipment. Considerable reaching, stooping bending,kneeling and/or crouching. Visual acuity and hearing to perform required nursing skills.7. Must be a licensed driver with an automobile that is insured in