Hospice RN Case Manager

Location Detail: MMH-8 Keynote Drive (10628)

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The Greater Manchester Region has approximately 2,500 employees. It includes Manchester Memorial Hospital, a 249-bed community hospital, Rockville General, a campus of Manchester Memorial Hospital, a 102-bed facility, a large multispecialty provider group and visiting nurse services. The Greater Manchester Region serves a region of 300,000 people in 19 towns.

General Summary of Duties: The provision of intermittent nursing service to patients in their homes under a plan of care established in collaboration with the patient's physician and according to agency policy and procedures uses hospice concepts and promotes quality of life for the terminally ill.

Supervision Received: Reports directly to the Hospice/Palliative Clinical Supervisor.

Supervision Exercised: Home Care Aides.

Typical Physical Demands: Requires full range of body motion including handling and lifting patients, manual and finger dexterity, and eye-hand coordination. Requires standing, walking, and the ability to ascend and descend stairs. Occasionally, lifts and carries items weighing up to 30 pounds. Requires corrected vision and hearing to normal range. Requires working under stressful conditions. Requires some exposure to communicable diseases and/or bodily fluids.

Typical Work Conditions: Work is performed in patients' homes and in an office environment. Some exposure to communicable diseases, toxic substances, and medicinal preparations.

Essential Duties: (This list may not include all of the duties assigned.)

1. Admits/readmits patients and provides intermittent nursing service to patients and their families in compliance with agency policies/procedures and state and federal regulations, incorporating the following:

a) A complete physical and psychosocial assessment.

b) Develops and implements an appropriate care plan and therapeutic goals with the patient/family.

c) Evaluation of patient safety on a 24-hour basis.

d) Exercises appropriate clinical judgment in coordination of patient care by all services involved.

e) Ongoing evaluation of significant changes in the condition of the patient and of progress toward the therapeutic goals.

f) Use of Agency and community consultants/resources.

g) Instruction of patient/family in procedures or responsibilities they are assuming and optimum wellness practices.

h) Planning for the patient's discharge from service.

i) Appropriate implementation and utilization of OASIS system.

j) Consults with patient/family regarding the process of dealing with issues of ethical concern.

2. Documents all services provided in the clinical record in accordance with state and federal regulations and Agency policy:

a) All records are complete, accurate, and done in timely fashion:

· admissions within 24 hours from first visit.

· subsequent visits within 48 hours.

b) Obtains physician verbal/written orders and complies with all reporting requirements.

c) Participates in coordination of care with physicians and with other disciplines as appropriate.

3. Manages work assignment in effective and efficient manner:

a) Reports any cases to the Hospice/Palliative Clinical Supervisor where goals can not be met or at-risk situations exist and responds appropriately.

b) Remains flexible in daily planning, allowing time for emergencies or unexpected visits.

c) Maintains productivity as established by the Agency.

d) Utilizes payor sources correctly, reflecting changing levels of care.

e) Delegates patient care responsibilities to Home Care Nurse (LPN) as appropriate.

f) Participates in the development of the hospice interdisciplinary team care plan.

4. Establishes the plan of care to be delegated to the Homemaker/Home Care Aide/Companion, orients and supervises the home care aide in accordance with state and federal regulations and Agency policy:

a) Develops an initial written plan of care for the HMK/HCA/Companion and…