RN Case Manager - Home Care

JOB SUMMARY
The RN Case Manager is a member of the interdisciplinary team who works to meet the physical, medical, psychosocial, emotional, and spiritual needs of hospice patients and families facing terminal illness and bereavement. The RN Case Manager provides coordination of care, ensures continuous assessment of each patient's and family's needs, and implements the interdisciplinary plan of care. In addition to providing for the unique needs of each individual patient, the RN Case Manager will work to provide a superior customer service experience to our long-term care partners. This position is hands on. Must support the Connecticut Hospices vision, mission, and operating principles.

GUIDING PRINCIPLES

• We provide quality, compassionate, and competent hospice and palliative care.
• We support families with their decision-making.
• We support families with participation in caring for their loved ones.
• We aid in enhancing the quality of life for all of our patients, for as long as their life lasts.

ESSENTIAL DUTIES AND RESPONSIBILITIES
General:

• Must be a member of the interdisciplinary team who will work to meet the physical, medical, psychosocial, emotional and spiritual needs of hospice patients and families facing terminal illness and bereavement.
• Provides coordination of care.
• Ensures continuous assessment of each patient's and family's needs and implements the interdisciplinary plan of care.
• Must specialize in managing The Connecticut Hospices patients who reside in skilled nursing or assisted living communities.
• Must provide superior customer service for each individual patient and their unique needs as well as our long-term care partners.
• Have passion for working with elderly individuals and enjoy the long-term care environment.
• Professionally manages/coordinates the hospice plan of care.
• Assesses, plans, implements, and evaluates the ongoing care needs of patients and families and the responses to interventions in collaboration with other disciplines.
• Supervises patient care rendered by licensed practical nurses, home health aides, and volunteers. This includes orientation, education, and supervisory visits.
• Coordinates the services provided by all disciplines and community services.
• Appropriately identifies/utilizes resources, referrals such as PT, OT, Home Health, Dietary, Pharmacy, Supplies, Home Medical Equipment, and other visits/consults.
• Work closely with staff of long-term care facility to ensure coordination of care and meet the expectations of the facility. Which includes timely communication, ensuring records are maintained and up to date, and participation in care coordination meetings with facility staff.
• Provides education, supervision, and counseling to patient and family regarding patient care needs. Utilizing agency education material as appropriate.
• Provides education to patients, families, caregivers, and referral sources.
• Conducts facility/staff in-servicing on topics related to hospice care at request of Connecticut Hospice or long-term care facility.
• Completes documentation at the time of the event and at the location of care unless otherwise directed in addition to the written communication to facility (based on their procedures) following each patient visit.
• Participates in the on-call rotation and/or provides shifts during non-business hours such as evenings, weekends and holidays based upon program-identified needs.
• Participates in bereavement support.
• Maintains focus on the patient and family experience of care.
• Appropriately handles patient/family/customer complaints with supervisor.
• Participates in training activities internally within Connecticut Hospice and externally as assigned.
• Participate in the agencys continuous quality improvement program and assigned IDT meetings.
• Communicates effectively and tactfully with patients, recognizing their age, cultural diversity, needs, abilities, personal preferences, and physical condition.
• Provides nursing that demonstrates competent nursing skills.
• Demonstrates competencies in all skills required for best clinical practice.
• Demonstrate ability to utilize assessment data to address physical and psychosocial needs of patients.
• Demonstrates understanding of nursing process, interpersonal relationships, and dynamics.
• Maintains positive professional demeanor.
• Work as directed by Supervisor.

Health & Safety:

• Report and take required action regarding injuries, incidents, medical, and accidents required by policy.
• Make the health, safety, protection of rights, and the development of patients and co-workers your primary responsibilities.
• Effectively manage medical and first aid emergencies.
• Follow all agency safety/medical related policies and procedures.
• Follow fire evacuation and disaster procedures correctly and in a timely manner.
• Report unsafe situations immediately; ensuring safety is imperative.
• Ensure pertinent emergency telephone numbers are readily available.
• Report symptoms and signs of communicable diseases immediately.
• Consistently use universal precautions.
• Report any incident that could potentially result in negative reactions from the community, law enforcement officers, and other agencies to the supervisor immediately.

EDUCATIONAL REQUIREMENTS, QUALIFICIATIONS, and TRAININGS

• Must possess current CT RN License in good standing.
• Minimum of one year experience in hospice, home care or long-term care.
• Maintains current CT drivers license and auto insurance.
• Must have excellent communication skills and speak in public.
• Must pay attention to details.
• Capacity to maintain accurate records and exercise discretion in handling of confidential information.
• Willingness to work a flexible schedule; including at different sites and programs as needed.
• Ability to maintain assigned work hours.

COMPUTER AND SOFTWARE REQUIREMENTS

• Computer literate and proficient in Microsoft Office Word and Excel, Outlook, plus word processing and presentation software.
• Ability to operate media equipment such as tablets, smartphones, and other electronic equipment.
• Ability to work with general office equipment.
• Ability to work with and understand databases a must and the ability to learn technical skills.

PHYSICAL REQUIREMENTS & WORK ENVIRONMENT

• Shall have essential physical skills; be able to run, squat, stoop/bend, kneel, climb stairs, be able to lift at least 50 pounds (or ¼ own body weight), push/pull against potential resistance, and be able to implement non-physical and physical interventions and CPR with individuals supported when needed.
• Shall have adequate vision, reading, writing, and documentation skills, and hearing to perform the essential functions of the job.
• Must have enough endurance to perform tasks over long periods of time.
• Will be engaged in speaking, sitting, walking, driving, listening, and in communicating both orally and in writing while performing his or her duties.
• Must be able to listen and respond to questions and instructions.

The qualifications, physical demands, and work environment described herein are representative of those an employee will encounter and must meet to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. The requirements listed in this document are the minimum levels of knowledge, skills, or abilities.

This document does not create an employment contract, implied or otherwise, other than an "at will" relationship.
The above noted job description is not intended to describe, in detail, the variety of tasks that may be assigned but rather to give the incumbent a general sense of the responsibilities and expectations of his/her position. As the nature of business demands change, so, too, may the essential functions of this position.