Hospice

Registered Nurse Care Manager

At Augusta Health, your work matters and so do you. Whether you're delivering direct patient care, supporting operations, or innovating behind the scenes, every role contributes to our mission of promoting wellness and healing through compassionate service. We offer more than just a job we offer a purpose-driven career in a nationally recognized, independent health system located in Virginia's scenic Shenandoah Valley.

Our team members thrive in a supportive culture that values collaboration, integrity, and excellence. With opportunities across clinical and non-clinical areas, Augusta Health is a place where your skills make a difference, and your growth is a priority.

The Registered Nurse Care Manager is responsible for managing and coordinating the plan of care for hospice patients in their place of residence and to coordinate care with the Interdisciplinary Team, patients, families, referring agency/facility, and/or caregivers. The RN administers nursing care for patients utilizing all aspects of the medical plan and nursing standards of care. Directs and guides patient/family education and the activities of other personnel while maintaining standards of professional nursing. Must possess the ability to assess data reflective of the patient's status and interpret the information to formulate a plan of care based on the patient's age-specific needs. Must be able to provide the care needed as described in the department's policies and procedures.

This position plays a critical role in supporting Augusta Health's mission and advancing departmental goals through measurable performance indicators and service excellence. This position contributes to a collaborative, patient-centered environment and helps drive outcomes aligned with organizational priorities.

Essential Job Duties:

• Medications: Completes 5 Rights with 100% compliance. Knowledge of medications used. Knowledge and use of high-risk medications. Ability to perform calculations for mixtures/solutions. Reconciles patient medications and changes in medications with physician/provider.
• Evaluation: Evaluate patient outcome: Implements/develops/documents the plan of care to ensure quality and continuity of care and recommend revisions to the plan, as necessary. Documentation reflects nursing interventions, patient responses, as well as follow through with patient outcomes. Consults with and educates the patient and family regarding disease process, self-care techniques, end-of-life care, nutrition, and dietary needs. Prioritize any needs with the members of the IDT. Provide training to other staff as needed. Prepares clinical and progress notes that demonstrate progress toward established goals. Ensure continuity of quality patient care delivered with appropriate documentation. Evaluation of age specific instruction/teaching is demonstrated and documented through monitoring of the learning process, seeking feedback from patients and family, and return demonstration if appropriate. Responsible for improving patient outcomes and comfort at end-of-life. Responsible for fiscal utilization of services/supplies per patient.
• Assess/Plan: Initial and ongoing comprehensive assessments are complete and appropriate for patients age, special care needs, patient's knowledge level, and psychosocial, emotional, physical, functional, environmental, and spiritual needs. Applies specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient's eligibility. Reassessment is timely and performed as patient condition warrants. Informs physician/provider and other team members of changes in the patient's needs and outcomes of intervention, while evaluating patient and family response to care. All documentation is submitted in a timely manner and per documentation policy. Communicates patient information as necessary to the interdisciplinary team and other nurses as required. Appropriate referrals are made with evidence of follow-up documentation in the medical record.
• Personal Growth: Assumes responsibility for own personal education and developmental needs. Assesses personal learning needs and initiates methods to meet the identified needs through formal or informal education. Displays positive attitude and flexibility toward work unit. Cooperates with interdisciplinary team members and other units to meet the needs of the patient. No complaints from patients/family, other units, physicians or staff. Attends 50% of staff meetings. Attends in-services as required or requested by clinical manager. Maintains clinical competency. Abides by AH service standards.