Registered nurse/Farmington

RN Case Manager

DEFINITION

Plans and assesses care in order to maximize comfort for patients and families.

ESSENTIAL JOB FUNCTIONS

• Initiates home care assessment on assigned patients within 48 hours of admission.
• Re-evaluates patient/family with each visit at least bi-weekly.
• Attends interdisciplinary team meetings.
• Assume primary responsibility for a patient/family caseload that includes the assessing, planning, implementing, and evaluating phases of the nursing process.
• Initiate communication with attending physicians, other hospice staff members and other agencies as needed to coordinate optimal care and use of resources for the patient/family.
• Maintain regular communication with Patient Care manager to review caseload.
• Maintain regular communication with the attending physician concerning patient/family care needs and response to interventions.
• Obtain data on physical, psychological, social and spiritual factors that may influence patient/family health status and incorporate that data into the plan of care.
• Seek input from other team members regarding the patient plan of care to obtain knowledge and support.
• Maintain up-to-date patient records so that problems, plans, actions and goals are accurately and clearly stated and changes are reflected as they occur.
• Instruct primary caregivers, volunteers, and employed caregivers to provide care as indicated.
• Meet regularly with hospice nursing staff to review problems or unique issues from caseloads, share professional support, and exchange feedback aimed toward enhancing professional growth.
• Attend patient conference and facilitate discussion of issues from caseload for full staff discussion, consultation, and evaluation.
• Supervise and document observance of the home health aide delivery of care every two weeks.
• Assist other nurse/case managers including assuming primary responsibility for patients when necessary.
• Provide appropriate support at time of death and perform bereavement assessment if requested.
• Participate in agency’s orientation, in-service training and continuing education as requested.
• Participate in agency and community programs as requested to promote professional growth and understanding of hospice care.
• Coordinates acquisition of medical supplies and equipment as appropriate for patient/family.
• Identifies and responds to situations that require mandatory reporting of abuse, neglect, and intent to harm.
• Communicate with facility staff and document appropriately within the facilities.

WORKING CONDITIONS

• Contacts: Patients, families, volunteers, staff members, hospital/facility personnel, the general public and household pets.
• Physical Demands: Physical exertion—walking, lifting, pulling, driving, step climbing, flex hours and travel.
• Environmental Conditions: Exposed to infections, communicable diseases, odors, blood, excreta, hazardous materials and/or high crime neighborhoods.
• Working Conditions: Periods of stress—variable workloads and deadlines.  Light office work.  Some evening work will be required.  Exposed to terminally ill patients and their families. 

• It is the responsibility of all employees to learn and utilize continuous quality improvement principles in their daily work.
• All employees are responsible for extending the mission, values and being “Love in Action" by understanding each customer, treating each patient, staff member, and community in a dignified manner with respect, kindness, and understanding, and subscribing to the agency’s commitment to quality service.

EMPLOYMENT QUALIFICATIONS

• Graduate of an accredited school of nursing and possesses a current license to practice as a registered nurse in the State they are working.
• Prefer a RN with C.H.P.N.
• Minimum five years of varied work experience as a professional nurse and preferably one to two of those years in hospice.
• Demonstrated ability to assess and respond to the needs of patients and families in varied settings.
• Demonstrated skill in nursing practice, ability to cope with family emotional stress and tolerance of individual lifestyles. 

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