Compassionate Hospice RN Needed in Worcester Area!

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

ESSENTIAL JOB FUNCTIONS/RESPONSIBILITIES
Patient Care:
Completes an initial, comprehensive, and ongoing assessment of patient and family to determine hospice needs. Provides a complete physical assessment and history of current and previous illness(es).
Provides professional nursing care by utilizing all elements of the nursing process and as defined in the state Nurse Practice Act.
Assesses and evaluates patient’s status by writing and initiating plan of care.
Regularly re-evaluating patient and family/caregiver needs
Participates in 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.
Develops a care plan that establishes goals, based on nursing diagnosis and incorporates palliative nursing actions. Includes the patient and the family in the planning process.
Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician’s plan of care.
Counsels the patient and family in meeting nursing and related needs.
Provides health care instructions to the patient as appropriate per assessment and plan.
Assists the patient with activities of daily living and facilitates the patient’s efforts toward self-sufficiency and optimal comfort care.
Maintain current documentation on EMR system by end of day according to organization policies/procedures and applicable laws/regulations.
The RN Case Manager, when assigned by the Clinical Manager/DPS, assumes responsibility to coordinate patient care for an assigned caseload.
The RN Case Manager may act as an Admission Nurse when assigned by Clinical Manager/DPS and assumes responsibility to coordinate with intake, program staff and
management to complete a patient initial admission/assessment with plan of care.
Creates and maintains schedule for nursing and HHA services in accordance with established plan of care and federal/state regulations.
Coordinates with interdisciplinary team regarding visit frequencies for all direct care personnel.
Orders medications, DME, medical supplies, and therapies as approved by the interdisciplinary group.
Coordinates with Clinical Manager Medication, DME, supplies, or therapies outside of formulary.
Performs medication reconciliation upon admission and as needed in coordination withinterdisciplinary group.
Communication:
Completes, maintains, and submits accurate and relevant clinical notes regarding patient’s condition and care given in accordance state and federal regulations. Records
pain/symptom management changes/outcomes as appropriate.
Communicates with the Hospice Medical Director and attending physician if elected regarding the patient’s needs and reports changes in the patient’s condition;
obtains/receives physicians’ orders as required.
Communicates with community health related persons to coordinate the care plan.
Teaches the patient and family/caregiver self-care techniques as appropriate. Provides medication, diet and other instructions as ordered by the physician and recognizes and
utilizes opportunities for health counseling with patients and families/caregivers. Works in concert with the interdisciplinary group.
Provides and maintains a safe environment for the patient.
Assists the patient and family/caregiver and other team members in providing continuity of care.
Works in cooperation with the family/caregiver and hospice interdisciplinary group to meet the emotional needs of the patient and family/caregiver.
Attends interdisciplinary group meetings.
Reports any incidents, concerns, or complaints to Director of Patient Services and/or administrator.
Ensures facility binders are up to date in accordance to state, federal, and accrediting agency regulations or standards.
Reviews non-covered items with patient, family, and/or facility as requested.
Completes and provides NOMNC to patient and/or family as required by state or federal