Position : RN Case Manager

Reports to : Director of Patient Care

Department : Patient Care Services

FSLA Status: Exempt

Job Summary: The RN Case Manager is responsible for coordinating care of assigned patients; performing skilled assessments of patient's physical, emotional and mental condition; providing skilled interventions and instructions to patients and families to provide optimal symptom control and patient comfort; and functions as a liaison between all disciplines providing care.

Supervises : Patient Care

Required Qualifications :

Knowledge/Skill/Ability:

· Demonstrates ability to assess and respond to the needs of the patient/family in highly emotional and stressful situations.

· Skilled in assessment, intervention and communication techniques.

· Ability to clearly articulate and teach information related to hospice/end-of-life care.

· Thorough understanding of hospice admission criteria.

· Demonstrates ability to develop and revise care plans to address individual patient needs and goals.

· Demonstrates understanding, awareness and acceptance of various cultures, values and approaches to healthcare, dying and loss.

Equivalent Education/Experie n ce:

· RN licensure, state of Oklahoma, Bachelor degree preferred.

· 1 year experience in a setting where demonstration of assessment and intervention skills can be documented.

· Previous home health or hospice experience preferred.

Certifications/Licenses:

· Valid Oklahoma Drivers License and automobile insurance verification

· Current state registration and licensure to practice as a registered nurse in Oklahoma.

· Certified Hospice and Palliative Care Nurse (CHPN) preferred.

Physical Requirements:

· See page 3, Physical Requirements.

Special Job Dimension:

· Must be tolerant of all lifestyles, cultures and spiritual beliefs.

· Must be able to work in substandard housing.

· Dependable transportation.

Key Responsibilities/Essential Functions :

· Coordinates direct and indirect nursing care for assigned patient/family caseload of 10—12 patients utilizing data on physical, psychological, social and spiritual factors that may influence patient/family health status. Caseload for part-time case manager adjusted as appropriate for FTE.

· Facilitates patient/family care conferences and educates patient and family about the disease process and the administration of care for the patient.

· Works with the attending physicians, community agencies, Director of Patient Care, support services staff and all other hospice staff members as appropriate to maximize available resources for the patient and their families.

· Assures continuity of care through participation in daily report, staff meeting and IDG meetings.

· Documents and reports pertinent data related to patient/family nursing care according to agency policy.

· Participates in IDG meetings for the development, review and revision of care plans, problem solving and professional support. If scheduled off during IDG, prepares appropriate documents and reviews with Director of Patient Care. Obtains physician orders before implementing recommendations made by Medical Director and/or other team members.

· Participates in covering call in the absence of the On-Call nurse.

· Assumes care responsibilities in absence of other RN case managers as assigned by Director of Patient Care.

· Participates in conducting orientation and in-service training programs.

· Participates in agency and departmental CQI, marketing, fund raising and public relations.

· Organizes workday in a manner to meet patient needs while still considering efficient use of time and mileage. I.E. calling patients each morning to schedule visit, thus identifying supplies needed and special time constraints

· Additional Key Responsibilities for RN Case Manager:

· Meet visit expectations of approximately 20 visits each week. Visit expectations of part-time case manager adjusted as appropriate for FTE.

· Complete supervisory visits on home health aide services per agency policy

· Obtain follow-up orders on consulting services visits: i.e. nutrition, wound/ostomy, therapy.

· Performs related responsibilities as required or assigned and within the scope of demonstrated competencies.

· Maintain any HGC equipment supplied, such as laptop, phone, etc., and return items in working condition when employment ends.