Demo

RN - Patient Care Coordinator

Seasons Hospice
Rochester, MN Full Time
POSTED ON 1/21/2025
AVAILABLE BEFORE 3/21/2025

Department Nursing

Location Homecare/Office

Reports to Clinical Services Manager

Next Review Date 12/2025

Mission Statement

To provide individualized and compassionate care, education, and support for the dying and those who have

experienced loss.

Position Summary

This position is responsible for coordinating and overseeing the delivery of comprehensive care to hospice patients

wherever they call home in accordance with the Interdisciplinary Team (IDT) Plan of Care.

Position Qualifications

  • Education and Training:

o Required: Associate’s or Bachelor’s degree in Nursing from a nursing program. If the nursing program

was not accredited, at least one year of RN experience in an applicable care setting required.

o Preferred: Associate’s or Bachelor’s degree in Nursing from an accredited nursing program.

  • Experience:

o Preferred: 2 years of experience working as an RN in a healthcare or hospice setting.

  • License or Certification:

o Required: Active and unrestricted RN license in MN.

o Required: Basic Cardiac Life Support for healthcare providers. Must complete within 3 months after start

date if certification is not current.

o Required: Valid driver’s license with acceptable driving record.

Position Duties and Responsibilities

  • Assessment and Care Planning:

o Conduct comprehensive assessments of patients' physical, psychosocial, and spiritual needs,

collaborating with the interdisciplinary team to develop individualized care plans.

o Evaluate patients' symptoms, pain levels, and overall well-being, identifying areas for intervention and

developing appropriate care strategies.

o Coordinate with members of the interdisciplinary team to ensure holistic care planning that addresses

patients' diverse needs and preferences.

  • Skilled Nursing Care:

o Provide skilled nursing interventions and treatments to address patients' clinical needs, including

medication administration, wound care, pain management, and symptom control.

o Monitor patients' response to treatment, assess for changes in condition or symptom progression, and

collaborate with the interdisciplinary team to adjust care plans accordingly.

o Offer emotional support, counseling, and education to patients and families, addressing concerns,

fears, and questions related to end-of-life care and symptom management.

  • Coordination of Care:

o Serve as the primary point of contact for patients, families, and caregivers, coordinating care services,

scheduling visits, and ensuring continuity of care.

o Facilitate communication and collaboration among interdisciplinary team members, ensuring that care

plans are implemented effectively and consistently.

o Coordinate transitions of care, including admissions, discharges, and transfers, to ensure seamless

transitions and optimal patient outcomes.

o Conduct regular case conferences, team meetings, and interdisciplinary rounds to review patient

status, discuss care plans, and address complex clinical issues.

o Participate in interdisciplinary team meetings, care conferences, and care planning sessions to review

patients’ progress, discuss care goals, update patient care plans and address any other patient care

concerns.

  • Clinical Oversight and Support:

o Provide clinical oversight, support, and training to other nursing and hospice aide staff, guiding them in

the delivery of high-quality, compassionate care to hospice patients.

o Responsible for completing Hospice Aide supervisory visits; as required.

  • Patient and Family Education:

o Provide education and support to patients, families, and caregivers about hospice services, goals of

care, symptom management, and end-of-life care options.

o Offer guidance and resources to help patients and families navigate the hospice experience, including

advance care planning, community resources, and psychosocial support services.

o Empower patients and families to actively participate in their care journey, advocating for their

preferences, values, and goals throughout the hospice experience.

  • Patient and Family Advocacy:

o Advocate for the needs and preferences of patients and families, ensuring that their voices are heard

and respected throughout the care process.

o Provide emotional support and education to patients and families, addressing concerns, fears, and

questions related to end-of-life care.

o Collaborate with social workers, chaplains, and other support services to provide comprehensive

psychosocial and spiritual support to patients and families.

  • Documentation and Regulatory Compliance:

o Maintain accurate and timely documentation of assessments, interventions, and patient/family

interactions in patients' electronic medical record and other required documentation systems, within 24

hours of contact.

o Ensure compliance with Medicare Hospice regulatory standards and MN Standards of Practice.

o Provide care consistent with National Hospice and Palliative Care Organization Standards of Practice

for Hospice Programs.

  • Professional Development and Training:

o Participate in ongoing professional development activities, including continuing education and training

to enhance skills and knowledge.

o Stay informed about best practices and emerging trends in clinical hospice care.

  • Other Duties

o Participates in on-call/holiday rotation.

o Participate in coverage for PTO taken by the On Call RN position.

o Serve in the role of back up Admission RN; as needed.

o Cover nursing shifts at the Hospice House, as needed or available.

Physical Demands

Sedentary (Requires lifting 10 lbs., carrying small objects)

Light (Requires lifting 20 lbs., with occasional carrying of up to 20 lbs.)

Medium (Requires lifting 50 lbs., with occasional carrying of up to 25 lbs.)

Heavy (Requires lifting 100 lbs., with occasional carrying of up to 50 lbs.)

Very Heavy (Requires lifting over 100 lbs., with occasional carrying of up to 50 lbs.)

Supervising Responsibilities

Yes - The position has direct supervising responsibilities

No - The position does not have supervising responsibilities

Travel Requirements

The position requires regular use of an insured, reliable vehicle for travel throughout Seasons Hospice service area.

The position requires occasional use of an insured, reliable vehicle for travel.

The position does not require travel.

Agency Expectations

  • Adhere to all Seasons Hospice policies and procedures.
  • Adhere to the Seasons Hospice Behavior Standards.
  • Adhere to all Health Insurance Portability and Accountability Act (HIPAA) rules and regulations.
  • Serve as an ambassador for Seasons Hospice.
  • Support the patients and family’s unique spiritual and cultural beliefs.
  • Respect for diversity in the workplace.
  • Participate in the employee performance review process.
  • Demonstrate ongoing responsibility for self-education.
  • Maintain personal and patient safety, as appropriate to position in the agency.
  • Actively participate in committees within the agency.
  • Attend scheduled department meetings and agency meetings on a regular basis.
  • Occasional flexibility with work schedule and regularly scheduled work hours.
  • Participate in the Quality Assessment Performance Improvement Program (QAPI); as requested.
  • Participate in orientation, training, and education of new employees and volunteers; as requested.
  • Participate in orientation and supervision for students seeking experience in hospice care; as requested.
  • Assume responsibility for the promotion of the hospice concept in the community and with other agencies and

professionals.

  • Participate in orientation of new employees, as requested.
  • Perform other duties as requested and/or assigned.

This job description is only a summary and is not designed to cover or contain a comprehensive listing of activities,

duties or responsibilities that are required of the employee. Nothing in this job description restricts management’s right to

assign or reassign duties and responsibilities to this job at any time. This job description is subject to change at any time

with or without notice.

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Job openings at Seasons Hospice

Seasons Hospice
Hired Organization Address King of Prussia, PA Full Time
Details Client Name Seasons Hospice (Parent) Job Type Travel Offering Nursing Profession Specialty Job ID 15706658 Job T...

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