Hospice RN Case Manager

Overview Works under the supervision of the Nurse Manager and the Director and is responsible for the assessment, planning, implementation, and evaluation of total nursing care of assigned patients on an intermittent visiting basis. The RN may work in a variety of settings (typically in a home‑care type setting) and roles within Riverside Health System, utilizing communication, critical thinking, problem solving, and decision making to create a care plan for each patient based on physiological, psychosocial, and cultural diversity. The RN also supervises and delegates non‑professional personnel to ensure optimum patient care and works under the direction of leadership and a multi‑disciplinary team to provide comprehensive services or clinical care in accordance with Riverside Health System standards and facility goals. Responsibilities Assess, plan, implement, and evaluate nursing care of assigned patients on an intermittent visiting basis. Develop an initial and ongoing comprehensive assessment of client needs, including the impact of terminal diagnosis on physical, functional, psychological, and environmental needs. Assess patient risk for pathological grief, cultural and spiritual implications, and verbal/non‑verbal communication patterns. Assess caregiver ability to meet the patient’s immediate needs upon admission and throughout care. Determine scope and frequency of services based on acuity and patient/family needs. Accurately complete required clinical documentation per RHS standards, including patient notes, orders, certifications, and recertifications. Apply specific criteria for admission and re‑certification to hospice care to establish appropriate levels of care and eligibility. Initiate an individualized plan of care and recommend revisions when necessary. Manage patient discomfort and provide symptom relief. Provide services and treatments requiring specialized nursing skill related to palliative and end‑of‑life care. Consult, counsel, and educate patients and families about nursing needs, disease process, self‑care techniques, end‑of‑life care, and ethical concerns. Use a case‑management approach and refer patients to other services as needed. Coordinate all patient/family services and prioritize needs with interdisciplinary teams. Provide ongoing evaluation of patient and family response to care. Inform physicians and the IDT of changes in patient needs and plan of care. Initiate preventive and rehabilitative nursing procedures and provide treatments that contribute to physiological and psychosocial outcomes and stability. Prepare clinical and progress notes demonstrating progress toward established goals. Refer patients to other services as needed. Supervise LPN/LVNs and Home Health Aides in accordance with regulatory guidelines. Provide specialized hospice training to staff, family members, and informal caregivers. Participate positively in training and support of team members, volunteers, and students. Delegate and prioritize tasks appropriately to facilitate quality patient care. Recognize and respond to emergency situations. Evaluate own needs for support and use identified systems and resources to meet those needs. Qualifications Education: Registered Nurse (required). Bachelor’s Degree in Nursing (preferred). Experience in acute care (preferred). Licenses and Certifications Registered Nurse (RN) – Virginia Department of Health Professions (VDHP) (required). CPR/BLS Certification – American Heart Association/American Red Cross/American Safety and Health Institute (AHA/ARC) within 30 days of employment (required). Requirements Drive personal vehicle for RHS business 25% or more of the time to perform essential job functions. Valid driver's license required. #J-18808-Ljbffr