RN Case Manager - Home Hospice

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift

Day (United States of America)

Job Summary

Fulltime Day Clinicial Home Hospice Care- travel daily to multiple hospice patients in Wellstar territory providing Medical care and support for patients as well as family in Home Hospice care.

Exceptional empathy and service skills.

Hospice RN experience strongly preferred with clinical excellence examples. 2 YRs RN in hospice preferred but will consider acute care with relevant experience.

The Hospice RN Case Manager utilizes the nursing process (assess, plan, implement, evaluate) to assume primary responsibility for the care of terminally ill patients and their caregivers in consultation with the primary physician, Hospice Medical Director and the Hospice interdisciplinary team.

RN Case Manager evaluates need and coordinates care from other disciplines including Clinical Care Partners, Social Workers, Chaplains, Bereavement Coordinators and Volunteers.

The hospice nurse provides physical and psychosocial support to the patient and supportive care to the caregiver and family that will assist them in accepting and preparing for the death of the patient. RN Case Manager reports to the Hospice Nurse Manager. Use of personal vehicle required. Mileage reimbursed.

Core Responsibilities and Essential Functions

Provides ongoing patient care according to the interdisciplinary care plan.

• Maintains ongoing contact with patients/families (phone calls, visits).
• Provides instruction regarding disease processes, symptom management, medication administration, and nutrition.
• Manages medications, ensuring they are available as ordered, administered correctly by family, stored correctly and safely, encourages compliance. educate regarding destruction of meds according to DEA guidelines
• Assesses symptoms and medication effectiveness, reports response to physician.
• Assesses disease procession and documents decline, adding additional complications to the ICD- code list.
• Assess need for change in level of care, based upon symptoms, caregiving fatigue and the patient/family plan for death. Facilitate transfer to appropriate care facility as needed.
• Assesses for patient safety, adequacy of caregiving, signs of abuse or neglect, suicide risk.
• Updates plan of care with goals, interventions and services that are indivualized to each patient/family need.

Prepares the Patient and Family for death.

• Conducts ongoing physical assessments of patients and anticipates changes based upon understanding of disease progression.
• Consults with primary physician appropriately.
• Advises caregivers of anticipated changes, educates about the signs and symptoms of impending death and interventions to relieve symptoms.
• Pronounces the patient at time of death.

Collaborates with members of the interdisciplinary team.

• Participates in interdisciplinary team meetings, family conferences and case studies.
• Interprets medical status of patients.
• Maintains ongoing communication with other members of the interdisciplinary team.
• Develops the hospice aide (CCP) personal care plan and supervises their implementation of the plan of care. Documents completion of supervision and annual competencies
• Serves as resources to staff with regard to medical issues.
• Coordinates care and transfer to in-patient hospice facility to provide highest level of trust for patient/family and provide continuity of care.
• Reads all communications and e-mails from team members including supervisors.

Implements state/federal licensure guidelines and JCAHO standards relating to nursing component of care.

• Maintains current documentation in electronic medical record.
• Maintains medical component of careplan.
• Monitors the quality of nursing care provided to patients including but not limited to safety and infection control.
• Performs customer satisfaction/complaint resolution activities in a timely manner and reports occurances to supervisor.

Communicates appropriately with contracted personnel (PT, ST, OT, ET) and agencies (pharmacies, DME company).

• Communicates/consults with contracted pharmacies.
• Provides pertinent information to contracted personnel as needed.
• Assesses need for DME

Supports and participates in performance improvement activities.

• Participates in department performance improvement activities (i. e. chart review, committees, etc.).
• Participates in system-wide committees as requested.
• Identifies methods for improving department performance/care.
• Assists in implementing performance improvement opportunities.

Demonstrates Leadership Skills

• Serves as a clinical resource for PRN RNs, on-call RNs, LPNs and CCPs
• Participates in the hiring and orientation of new nursing staff.
• Assumes additional responsibilities: committee assignments, education of students, peer review, case study analysis.

Performs Other Duties as Assigned

Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education

Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Required Minimum License(s) and Certification(s)

• All certifications are required upon hire unless otherwise stated.
• RN - Reg Nurse (Single State) or RN-COMPACT - RN - Multi-state Compact
• BLS - Basic Life Support or ARC-BLS - Amer Red Cross Basic Life Support or BLS-I - Basic Life Support - Instructor
• GADL - Georgia Driver's License or VSDL - Valid State Driver's License
• PVI - Private Vehicle insurance

Additional License(s) and Certification(s)

CHPN - Cert Hospice Palliative Nurse Upon Hire Preferred and

Required Minimum Experience

Minimum 2 years acute care or hospice/home care experience Preferred

Required Minimum Skills

• Possesses emotional maturity.
• Possesses interpersonal skills.
• Demonstrates excellent assessment and clinical judgment skills.
• Possesses knowledge of developmental characteristics (physical, psychosocial, intellectual) of people of all ages (neonate, infant, child, adolescent, adult, geriatric).
• Possesses knowledge of disease processes affecting people of all ages.
• Demonstrates effective written and verbal communication skills.
• Demonstrates effective use of computers for patient care documentation.

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