Hospice Registered Nurse Case Manager

Affinity Health Management; Windham (ME); On-site; USD 70,000 - 90,000; Full time

Job summary

Affinity Health Management seeks a dedicated registered nurse to plan, organize, and direct hospice care in patients' homes and communities. The role emphasizes community health education and coordinating across the care team to meet patient and family needs.

The RN will assess patients, develop care plans, provide nursing care, and act as Case Manager as assigned. Strong communication, assessment, and CPR certification are essential for success.

Qualifications

• Graduate of an accredited nursing program with active RN license.
• Current RN license in good standing.
• One year of nursing experience in the last three years, or a BSN with two years in public health/home care/hospice preferred.
• Management experience not required; may supervise hospice aides.
• Successful references and background checks after offer.
• Excellent observation and communication skills; problem solving and basic math.
• Ability to stand/walk for long periods; able to lift and transfer patients.
• Valid driver’s license with insured vehicle.
• CPR certification required.

Responsibilities

• Conduct comprehensive initial and ongoing patient/family assessments to identify hospice needs.
• Provide professional nursing care per the physician's plan of care.
• Develop and revise care plans with patient and family involvement.
• Initiate and revise plans of care as patient status changes.
• Coordinate patient care as Case Manager when assigned.
• Document clinical notes and report changes to physician.
• Participate in on-call duties and ensure equipment/services are available.
• Supervise hospice aides as appropriate; maintain patient safety and comfort.

Skills

Communication skills

Verbal communication

Written communication

Problem solving

Basic math

Nursing skills

Physical stamina

Driver's license

CPR certified

Supervisory ability

Education

Graduate of accredited nursing program

RN license in good standing

Experience within last 3 years or BSN with 2 years' public health/home care/hospice

CPR certification

Job description

JOB DESCRIPTION SUMMARY

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 from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities.

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES

Patient Care

• 1. Completes an initial, comprehensive and ongoing comprehensive assessment of patient and family to determine hospice needs. Provides a complete physical assessment and history 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 needs change.
• 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. Administers medications 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.
• 9. 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 toward self-sufficiency and optional comfort care.
• 11. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload.

Communication

• 1. Completes, maintains and submits accurate and relevant clinical notes regarding patient’s condition and care given. Records pain/symptom management changes/outcomes as appropriate.
• 2. Communicates with the physician regarding the patient’s needs and reports changes in the patient’s condition; obtains/receives physicians’ orders as required.
• 3. Communicates with community health related persons to coordinate the care plan.
• 4. As a mandatory reporter, reports failure to comply with the requirements of the Dept. of Health as required within 14 calendar days, using Dept. of Health forms.
• 5. Reports suspected abandonment, abuse, financial exploitation, or neglect of a person in violation of the department of social and health services and the proper law enforcement agency. Reports must be submitted immediately when the reporting person has reasonable cause to believe that abandonment, abuse, financial exploitation, or neglect of a vulnerable adult has occurred.
• 6. Teaches the patient and family/caregiver self‑care techniques as appropriate. Provides medication, diet and other instructions as ordered by the physician and recognizes and utilizes opportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary group.
• 7. Provides and maintains a safe environment for the patient.
• 8. Assists the patient and family/caregiver and other team members in providing continuity of care.
• 9. Works in cooperation with the family/caregiver and hospice interdisciplinary group to meet the emotional needs of the patient and family/caregiver.
• 10. Attends interdisciplinary group meetings.

Additional Duties

• 1. Participates in on‑call duties as defined by the on‑call policy.
• 2. Ensures that arrangements for equipment and other necessary items and services are available.
• 3. Supervises ancillary personnel and delegates responsibilities when required.
• 4. Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in‑service classes.
• 5. Fulfills the obligation of requested and/or accepted case assignments.
• 6. Actively participates in quality assessment performance improvement teams and activities.

POSITION QUALIFICATIONS

• 1. Graduate of an accredited school of nursing
• 2. Registered Nurse, with a License in good standing to practice.
• 3. Registered nurses shall have a minimum of (a) one (1) year of experience as a professional nurse within the last three (3) years; OR have a baccalaureate degree in nursing and minimum of two (2) years’ experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred.
• 4. Management experience not required. Responsible for supervising hospice aides.
• 5. Once an offer of employment is made, it is contingent upon satisfactory references, as requested, and criminal background checks by regulation.
• 6. Excellent observation, verbal and written communication skills, problem solving skills, basic math skills; nursing skills per competency checklist.
• 7. Prolonged or considerable walking or standing. Able to lift, position and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling and/or crouching. Visual acuity and hearing to perform required nursing skills.
• 8. Must be a licensed driver with an automobile that is insured in accordance with state/or organization requirements and is in good working order.
• 9. Possesses and maintains CPR certification (may not be internet based unless the demonstration of skills was hands on and observed by a certified trainer)