RN Case Manager (Registered Nurse Case Manager) (Fannin County)

JOB SUMMARY The registered nurse plans, organizes and directs hospice care and is experienced in nursing, with emphasis on community health education/experience. The professional nurse builds from the resources of the community to plan and direct services to meet the needs of individual and families within their homes and communities. MUST HAVE: Current RN license, Driver License, Auto Insurance, CPR DUTIES and RESPONSIBILITIES Patient Care - Completes an initial, comprehensive and ongoing assessments of patient and family to determine hospice needs. - Provides a complete physical assessment and history of current and previous illness(es). - Provides professional nursing care by utilizing all elements of nursing process. - Assesses and evaluates patients status by: Writing and initiating plan of care Regularly re-evaluating patient and family/caregiver needs Participating in revising the plan of care as necessary - Uses health assessment data to determine nursing diagnosis. - Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. - Includes the patient and the family in the planning process. - Initiates appropriate preventive and rehabilitative nursing procedures. - Administers medications and treatments as prescribed by the physician in the physicians plan of care. - Counsels the patient and family in meeting nursing and related needs. - Provides health care instructions to the patient as appropriate per assessment and plan. - Assists the patient with the activities of daily living and facilitates the patients efforts toward self-sufficiency and optional comfort care. - Acts as Case Manager and assumes responsibility to coordinate patient care for assigned caseload. Communication - Completes, maintains and submits accurate and relevant clinical notes regarding patients condition and care given. - Records pain/symptom management changes/outcomes as appropriate. - Communicates with the physician regarding the patients needs and reports changes in the patients condition; obtains/receives physicians orders as required. - Communicates with community health related persons to coordinate the care plan. - Teaches the patient and family/caregiver self-care techniques as appropriate. - Provides medication, diet and other instructions as ordered by the physician and recognizes and utilizes opportunities for health counseling with patients and families/caregivers. - Works in concert with the interdisciplinary group. Provides and maintains a safe environment for the patient. - Assists the patient and family/caregiver and other team members in providing continuity of care. Works in cooperation with the family/caregiver and hospice Interdisciplinary Group Members to meet the emotional needs of the patient and family/caregiver. - Attends interdisciplinary group meetings. Additional Duties - Participates in on-call duties as defined by the on-call policy. - Ensures that arrangements for equipment and other necessary items and services are available. - Supervises ancillary personnel and delegates responsibilities when required. - Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in-service classes. - Fulfills the obligation of requested and/or accepted case assignments. - Actively participates in quality assessment performance improvement teams and activities. The above statements are only meant to be a representative summary of the major duties and responsibilities performed by the employee of this job. The employee may be requested to perform job-related tasks other than those stated in this description. JOB REQUIREMENTS (Education, Experience, Knowledge, Skills and Abilities) Graduate of National League for Nursing accredited school of nursing. Minimum of two years of experience, at least one of which is in the area of public health, home care, or hospice nursing is preferred. Management experience not required. Responsible for supervising hospice aides. Registered nurse with current licensure to practice professional nursing in the state. Demonstrates excellent observation, problem solving, verbal and written communications; nursing skills per competency checklist. Shows ability to organize and prioritize workload independently. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping, bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills. Maintains a current CPR certification. The ability to drive and/or have access to transportation for agency related travel (e.g. community partners, patients, etc.) is an essential function of the job. Must have and maintain a valid drivers license, maintain automobile insurance coverage and have access to an automobile. Self-directed and able to work with minimal supervision. Job seekers with a felony conviction will be considered on a case by case basis.