Hospice Registered Nurse Case Manager

• Coordinates hospice care by working with other team members as well as with the patients/family members to ensure needs are met.
• Evaluate the effectiveness of hospice services to the patient and family on an ongoing basis.
• Perform evaluations for hospice care along with informational visits as needed.
• Utilize the nursing process to provide professional nursing care.
• Consult with the attending physician and Hospice Medical Director concerning changes in the patient's condition requiring order changes and/or changes in the plan of care.
• Coordinate patient services with other members of the IDG as well as contracted services, when needed.
• Submit complete, accurate and relevant clinical notes (through our Hospice MD) in a timely manner
• Submit patient visit schedule weekly
• Participate in IDG and case conferences
• Discuss with the supervisor if IDG determines that the patient would benefit from contracted services.
• Take responsibility for ensuring patients' plans of care are kept current.
• Perform on-call duties including nights,weekends, and holidays if needed. (we will ask in advance before scheduling you to be on-call)
• Actively participates in QAPI meetings and activities.
• Participate in staff development meeting.
• Continually strive to improve his/her/their nursing care skills by attending in-service education, through formal education, attendance at workshops, conferences, active participation in professional and related organizations and/or individual research and reading.
• Provide education to patients/family members regarding the dying process, plan of care and offers guidance with healthcare decisions.
• Provide dietary counseling, taking into account health issues and dietary changes at the end of life.
• Perform death visit per agency's policy.
• Participate in the patient's discharge planning process.
• Maintain an on-going knowledge of current drug therapy.
• Adhere to Federal, state and accreditation requirements including Medicare and Medicaid regulations.
• May be requested by a supervisor to fill in for the other nurses.
• Conduct in initial as well as ongoing comprehensive assessments of the patients.
• Obtain a medical history from the patient and/or a family member particularly as it relates to the present condition.
• Conduct a physical examination of the patient, including vital signs, physical assessment, mental status, appetite and type of diet, etc.
• Evaluate the patient, family members and home situation to determine what health teaching will be required.
• Evaluate the patients' environment to determine what assistance will be available from family members in caring for the patient and what services may be needed.
• Be competent in knowledge about different levels of care and when it's appropriate to offer them.
• Explain nursing and other Agency services to patients and families as a part of planning for care.
• Develop and implement the initial plan of care and work with other members of the IDG in completing and maintaining the comprehensive plan of care.
• Nursing services, treatments and preventative procedures requiring substantial specialized skill and ordered by the physician.
• Observing signs and symptoms and reporting to the physician reactions to treatments, including drugs, as well as changes in the patients' physical or emotional condition.
• Supervise and evaluate the care given by the Home Health Aide at a minimum of once every 14 days and as needed.
• Chart those services rendered to the patient by the staff nurse and changes that have been noted in the patient's condition and/or family and home situation, makes revisions in the nursing care plan as needed, records supervisory visits conducted with the Home Health Aide, evaluates patient care and progress and closes charts of discharged patients.
• Evaluate the effectiveness of his/her nursing service to the individual and family.
• Discuss with the supervisor problems concerning the patients and possible resolution.
• Provide guidance and supervision to the LVN and supervise the LVN once monthly
• Cooperate with other agencies providing nursing or related services to provide continuity of care and to implement a comprehensive care plan.
• Participate in staff development meetings.
• Prepare the care plan for Home Health Aide.

• May be stressful.
• The ability to access patients' homes which may not be routinely wheelchair accessible is required. Hearing, eyesight and physical dexterity must be sufficient to perform a physical assessment of the patient's condition and to perform and demonstrate patient care.
• Physical activities will include, walking, sitting, stooping and standing and minimal to maximum lifting of patients and the turning of patients.

• Utilization of calculator, telephone, copy machine, thermometer, blood pressure cuff, other basic office and medical equipment.

Requirements

• Registered Nursing License in California
• CPR Certification
• Physical Form signed by Doctor - (we provide this form)
• Recent TB Test and Titers (checks for previous vaccinations)
• Covid Vaccine Card (or Religious Exemption and Testing Agreement) - (we provide this form and testing in our Brentwood office location)
• 2 forms of ID (driver's license, social security card, passport)
• Auto Insurance
• Resume
• 2 References
• Good means of communication
• Reliable transportation