RN Case Manager

Our client in MA is looking for an RN Case Manager for a contract role. (possible contract to perm for right candidate) Job will be based in a specific area in MA. Will be responsible for coverage on the North Shore of Boston, each RN will have its own territory.

Locations : Burlington, Woburn, Stoneham, Winchester, Medford, Melrose, Malden, Revere, Chelsea, Winthrop, East Boston

40 hours per week. Monday- Friday 8-4 : 30. Must have reliable vehicle and travel to patient homes on the North Shore. (4-6 appointments per day; mileage is reimbursed)

Summary :

As a member of the interdisciplinary team, the RN Case Manager works under the supervision of a Clinical Manager or Hospice House Manager and the attending physician to coordinate all aspects of the patient's care in accordance with current professional standards and practice to maximize the comfort and health of patients and families.

Responsible for identifying patient / family needs and for providing supportive care in accordance with the attending physician's orders and plan of care and client's policies and procedures.

Qualifications :

• Registered Nurse, currently licensed in Massachusetts in good standing.
• Associate's degree in nursing required; Bachelor's degree in nursing, or equivalent preferred.
• Minimum three years of varied work experience as a professional nurse, and preferably one of the three years in an acute setting.
• Demonstrated ability to assess and respond to the needs of patients and families in varied settings.
• Skilled in nursing practice, able to cope with family emotional stress and tolerant of individual lifestyles.
• Demonstrated understanding of hospice philosophy and principles.
• Demonstrated ability to be self-directed, flexible and cooperative in fulfilling role obligation

and ability to work effectively within an interdisciplinary team.

• Must be a licensed driver with an automobile that is insured in accordance with state and / or organization requirements and in good working order.

Team Concept : Works with the interdisciplinary team to plan and coordinate care.

• Participates in ongoing comprehensive assessment, case conferences and other forums and coordinates plan of care.
• Participates in interdisciplinary team meetings and facilitates discussion of issues from caseload for full staff participation, consultation and evaluation.
• Supervises and directs appropriate others in the planning and implementation of patient care and works as a team member in promoting harmonious working relationships.
• Coordinates optimal patient care and use of resources for the patient / family through effective

collaboration with other hospice staff members, volunteers, attending physicians, and outside agencies.

• Maintains regular communication with the supervisor to review caseload; keeps managers informed of unusual or potentially problematic patient / family issues.
• Keeps attending physician informed of patient status through timely submission of documentation and regular telephone contact.
• Shares in providing 24-hour, seven day per week coverage to patients / families including on-call, holiday coverage and charge responsibilities as assigned.
• Maintains regular communication with fiscal staff and third party case managers and reviewers as needed to secure reimbursement for needed hospice services to patients and families.
• Performs other duties assigned as required or requested.

Patient Care : Assesses, plans, implements and evaluates the care of hospice patients in the home care, skilled nursing facility, and inpatient settings.

• Assesses patient's status by conducting an organized, systematic history and physical exam, and obtaining data about psychosocial and spiritual factors that may influence patient / family health status. Performs re-assessments at appropriate intervals.
• Performs initial and ongoing assessment of the impact of the terminal diagnosis on the patient's physical, functional, psychosocial and environmental needs and activities of daily living.
• risk of pathological grief
• cultural and spiritual implications
• verbal and non-verbal communication patterns

Develops an individualized plan of care for each patient in collaboration with other members of the interdisciplinary team, and revises and updates the plan as needed in accordance with client's policy.

• Maintains up-to-date patient records ensuring the problems, plans, actions and goals are accurately and clearly stated and changes are reflected as they occur.
• Accepts responsibility for coordinating physical care of the patient by teaching appropriate others or by providing direct care as appropriate.
• Provides clinical supervision to ancillary staff including hospice aides and volunteers.
• Documents required supervision in the patient record. Performs specialized procedures such as : care, maintenance and use of venous access devices, infusion pumps, titration and conversion of medications, when qualified by training, proven competency, clinical background and expertise in the procedure(s).
• Completes documentation according to established standards and ensures that documentation supports the appropriate level of care.
• Provides care at the time of death, including pronouncement, support to family and coordination of appropriate follow-up and communication.
• Provides appropriate support to families in bereavement, including making follow-up bereavement visits and providing input to the bereavement risk assessment and bereavement plan of care.
• Completes documentation for discharged patients within established time frame.
• Provides teaching for patients and families and documents same.
• Actively involves patients and families in the planning and provision of care.
• Anticipates and intervenes in potential problem situations / complications before they arise.
• Remains flexible and adaptable to patient needs by reprioritizing work for maximum efficiency.
• Organizes and delegates patient care responsibilities appropriately, and completes patient care assignments within scheduled shifts.
• Achieves defined productivity standards i.e., (caseload and / or visits per day / week) as appropriate to patient care setting.

Functional Abilities :

• Ability to transport self to patient's home / facility, may be multiple locations in a work day.
• Able to stoop and bend.
• Able to lift and carry effectively so as to be able to perform the above listed functions.
• Able to hear and speak in a manner understood by most people.
• Communicates effectively in English both orally and in writing sufficient to prepare and sendreports, and to interact with patients, staff and peers