Registered Nurse Case Manager

Overview

About Luminary Hospice:
Luminary Hospice is a mission-driven organization that empowers team members to shape our culture to provide the highest quality support to patients and families throughout the end-of-life journey. The organization delivers personalized care, focusing on the whole person with expert medical care, pain management, emotional and spiritual support, and resources for families and caregivers.

The Registered Nurse Case Manager plans, organizes, and directs hospice care and is an experienced nurse with an emphasis on community health education/experience. The professional nurse builds from community resources to plan and direct services to meet the needs of individuals and families within their homes and communities.

• Completes an initial, comprehensive assessment of the patient and family to determine hospice needs, including a complete physical assessment and history of current and previous illnesses.
• Provides professional nursing care by utilizing all elements of the nursing process.
• Assesses and evaluates patient status by writing and initiating a plan of care, regularly re-evaluating patient and family/caregiver needs, and revising the plan of care as necessary.
• Initiates the plan of care and makes necessary revisions as patient status and needs change.
• Uses health assessment data to determine nursing diagnosis and develops a care plan with goals based on nursing diagnosis, including patient and family in the planning process.
• Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the plan of care.
• Counsels the patient and family in meeting nursing and related needs and provides health care instructions as appropriate per assessment and plan.
• Assists the patient with activities of daily living and facilitates the patient’s efforts toward self-sufficiency and comfort care as applicable.
• Acts as Case Manager when assigned by Clinical Supervisor and coordinates patient care for the assigned caseload.

• Completes, maintains, and submits accurate and relevant clinical notes regarding the patient’s condition and care, including pain/symptom management changes/outcomes.
• Communicates with the physician regarding the patient’s needs and reports changes in condition; obtains/receives physician orders as required.
• Coordinates with community health-related persons to align the care plan.
• Educates the patient and family/caregiver on self-care techniques as appropriate and provides medication, diet, and other instructions as ordered by the physician; works with the interdisciplinary group to ensure continuity of care.
• Maintains a safe environment for the patient and collaborates with the family/caregiver and hospice interdisciplinary group to meet emotional needs; participates in interdisciplinary group meetings.

• Participates in on-call duties as defined by policy.
• Ensures that arrangements for equipment and services are available.
• Supervises ancillary personnel and delegates responsibilities as required.
• Pursues personal growth and maintains professional knowledge through continuing education and in-service classes.
• Fulfills assigned case work and actively participates in quality assessment and performance improvement activities.

• Graduate of an accredited school of nursing. Preferred: one to two years of recent acute care experience in an institutional setting, and one to two years in home care.
• Current licensure in the state and CPR certification.
• Bachelor’s degree, with one year of hospice care experience preferred.
• Management experience is not required; responsible for supervising hospice aides.
• Strong observation, verbal and written communication, problem-solving, and nursing skills per competency checklist.
• Physical ability to walk, stand for extended periods, lift/position/transfer patients, and handle supplies; visual and auditory capacity to perform nursing skills.
• Must be a licensed driver with a valid, in-good-condition vehicle and valid insurance in accordance with state/organization requirements.

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