Field RN Case Manager - Care at Home

Day (United States of America)

Field RN Case Manager - Care at Home

The Field RN will be responsible for coordination and implementation of the overall plan of care for the assigned patients in various hospice settings to assure the best possible quality of life is attained. Responsibilities include providing all aspects of care for the terminally ill patient, providing patient and family education, completing all regulatory requirements of nurses for patients on Hospice, performing patient assessment and documentation, providing symptom management, developing a comprehensive Interdisciplinary Plan of Care, orienting new staff, and participating in Quality Improvement activities.

- Graduated from an accredited nursing program.
- Valid Florida license to practice as a Registered Nurse.
- Minimum 1 year experience in Medical Surgical nursing or equivalent.
- Hospice Experience preferred.
- Certification in Hospice/Palliative preferred.
- Valid driving license and good driving record. 
- Ability to work within the interdisciplinary team framework and demonstrate good oral and written communication skills.
- Skilled in providing nursing care to pediatric, adolescent, adult and geriatric patients.
- Demonstrates good interpersonal skills, ability to cope with stress, maturity and emotional stability.
- Must meet criteria for employment by Halifax Health.
- Performs all duties, tasks and all requirements of case management of hospice patients and family. Overseeing all care delivered by the interdisciplinary team members (IDT).
- Ability to complete all aspects of the Hospice Intake & Admission process.
- Provides oversight of all care by the Interdisciplinary team members.
- Performs and documents all comprehensive and required physical assessments with a high rate of accuracy which reflect the patient’s current condition.
- Implements, documents and makes changes to the comprehensive interdisciplinary plan of care to reflect patient and family needs. Appropriate interventions and realistic patient/family goals are included in this plan with input from the interdisciplinary team including the attending physician.
- Represents Halifax Health-Hospice (HH-H) and utilizes effective communication methods and skills with all patient, family, facility staff, referral sources and coworkers.
- Demonstrates a positive, informative and productive working relationship with all members of the IDT, internal and external customers. Professional working relationships are maintained with hospitals, nursing homes, ALF’s, physicians’ offices, and all internal and external customers.
- Demonstrates a knowledge of clinical practice and performs nursing procedures in accordance with current best practice standards and organizational policies and procedures. Patient needs are met appropriately and in a timely manner.
- Demonstrates a knowledge of best practice in end of life care and support, pain and symptom management. Documentation in the medical record reflects appropriate interventions for optimal and ongoing pain and symptom management.
- Maintains communication with the physician.
- Identifies educational needs and provides appropriate education to patient/family and community partners.
- Demonstrates the ability to communicate accurate and relevant information regarding hospice benefits services, and represents HH-H in a positive and professional manner.
- Works as assigned to assist in providing hospice services 24-hour a day, 7 days a week, including Holidays.
- Meets or exceeds productivity standards for the assigned position.
- Demonstrates high level of efficiency in documenting in an electronic medical record (EMR). Documentation reflects required hours spent in direct patient contact and all work is completed within agency guidelines.
- Maintains all company owned equipment in good working order.
- Attends HH-H or other End of Life In-services and General Staff Meetings as required.
- Meets educational requirements for licensure and seeks appropriate education to enhance job performance.
- Participates in Quality Action Teams and other QI activities as assigned.