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Palliative Care RN/Case Manager for WellMed
Improve Your Quality of Life While Helping Others!
Join our exceptional growing WellMed team.
The Palliative Care RN/Case Manager coordinates care and provides initial ongoing nursing assessment of the patient and family needs and coordination of the patient's plan of care with interdisciplinary team members and the palliative care attending physician.
Essential Job Functions
- Conducts medical home visits on established Bridges in Complex Care patients performing a hands-on exam at each visit.
- Conducts urgent/acute visits on established Bridges in Complex Care patients with the goal of keeping the patient out of the hospital in order to receive the best medical care at home.
- Provides ongoing assessments of the impact of life-limiting chronic illness on the patient's physical, functional, psychosocial and environmental needs.
- Assess for caregiver burnout, and provide community resources when appropriate.
- Implement the individualized plan of care and recommend revisions to the plan as necessary.
- Ability to perform procedures, to include, but not limited to:
- Wound care and dressing changes
- Injection (B12, vaccines)
- Ability to conduct an advanced care discussion with a patient and their family and properly document their wishes in the electronic medical record.
- Consults and educates the patient/family and other caregivers regarding the disease process, pain and symptom management, end of life care and processes for dealing with issues of ethical concern.
- Initiates appropriate preventive and rehabilitative nursing procedures when appropriate.
- Ensure continual assessment of patient and family needs from admission to Bridges in Complex Care throughout the course of care.
- Provides ongoing evaluation of the patient and family/caregiver response to care, and recommends alteration of the plan when necessary.
- Attends the interdisciplinary meeting and is a crucial and vocal member of the team.
- Solves problems by gathering and/or reviewing facts and selecting the best solution from identified alternatives. Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures.
- Conducts telephonic nursing follow up and case management when necessary.
- Serves as a resource or consultant for LVN.
- Attends educational offerings to keep abreast of palliative care and complies with licensing requirements.
- Establishes a trusting relationship with identified patients, caregivers, clinic staff members and physicians.
- Collaborates with the providers to recommend policies, procedures and standards which affect the care of the Bridges in Complex Care Patient.
- Exhibits professionalism and is courteous with all patients, physicians and co-workers.
- Informs the provider of patient's needs and outcomes of interventions as per standards.
- Determines the scope and frequency of services needed based on acuity and patient/family needs.
- Coordinates all patient/family services and prioritization of needs with the members of the interdisciplinary team.
- Documents in the electronic health record progress toward established goals as per standards.
- Uses the case management approach and refers to other services as needed.
- Maintains a patient case load, daily visits and point of care documentation levels as per standards.
- Participates with the on-call rotation schedule and weekends as assigned.
- Performs all other related nursing duties as assigned.
- Registered Nurse with a current license to practice in the state of employment.
- Five or more years experience in a physician's office, clinical, hospice or hospital setting.
- 2+ years of hospice experience preferred
- Reliable transportation
- Demonstrated experience of excellent nursing skills.
- Proficient knowledge of palliative care and end-of-life symptom management.
- Experience related to advanced care planning and discussions with patients regarding end-of-life wishes.
- Excellent verbal and written skills.
- Ability to interact productively with individuals and with multidisciplinary teams.
- Proficient computer skills, including Microsoft Word, Excel, Access and Outlook.
- Excellent organizational and prioritization skills.
- Hospice and Palliative Care Nursing certification preferred
- Bilingual (Spanish/English)
WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.
Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.
WellMed is now part of the OptumHealth division under the greater UnitedHealth Group umbrella.
Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Keywords: rn, registered nurse, palliative care, hospice, san antonio , tx
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Job Category: Nurse
Job Reference Code: UHG-554209
Position Type: Full-Time