Registered Nurse Case Manager

Reports To: Director of Clinical Services

At Luminary Hospice, we are a mission-driven organization that empowers our team members to shape our culture in order to allow them to provide the highest quality support to patients and families throughout their entire end-of-life journey.

Our mission is to deliver personalized care that radiates compassion and preserves dignity for all that we are honored to serve on their end-of-life journey. We are centered on caring for the whole person – with expert medical care, pain management as well as emotional and spiritual support along with resources, information, and emotional support for families and caregivers.

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

Patient Care

1. Completes an initial, comprehensive, and ongoing comprehensive assessment of the patient and family to determine hospice needs. Provides a complete physical assessment and history of current and previous illness(es).
2. Provides professional nursing care by utilizing all elements of the nursing process.
3. Assesses and evaluates patient's status by:
4. Writing and initiating a plan of care
5. Regularly re-evaluating patient and family/caregiver needs
6. Participating in revising the plan of care as necessary
7. Initiates the plan of care and makes necessary revisions as patient status and needs change.
8. Uses health assessment data to determine nursing diagnosis.
9. 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.
10. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician in the physician's plan of care.
11. Counsels the patient and family in meeting nursing and related needs.
12. Provides health care instructions to the patient as appropriate per assessment and plan.
13. Assists the patient with the activities of daily living and facilitates the patient's efforts toward self-sufficiency and optional comfort care.
14. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility for coordinating patient care for assigned caseload.

Communication

1. Completes, maintains, and submits accurate and relevant clinical notes regarding the patient's condition and care given. Records pain/symptom management changes/outcomes as appropriate.
2. Communicates with the physician regarding the patient's needs and reports changes in the patient's condition; obtains/receives physicians' orders as required.
3. Communicate with community health-related persons to coordinate the care plan.
4. Teach 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.
5. Provides and maintains a safe environment for the patient.
6. Assists the patient's family/caregiver and other team members in providing continuity of care.
7. Works in cooperation with the family/caregiver and hospice interdisciplinary group to meet the emotional needs of the patient and family/caregiver.
8. Attends interdisciplinary group meetings.

Additional Duties

1. Participates in on-call duties as defined by the on-call policy.
2. Ensures that arrangements for equipment and other necessary items and services
   are available.
3. Supervises ancillary personnel and delegates responsibilities when required.
4. Assumes responsibility for personal growth and development and maintains and upgrades professional knowledge and practice skills through attendance and participation in continuing education and in-service classes.
5. Fulfills the obligation of requested and/or accepted case assignments.
6. Actively participates in quality assessment performance improvement teams and activities.

1. Graduate of an accredited school of nursing. Preferred, One (1) to two (2) years of recent acute care experience in an institutional setting, and one (1) to two (2) years of recent experience in home care.
2. Current licensure in State and CPR certification.
3. Bachelor's degree, with one (1) year of hospice care experience preferred.
4. Management experience is not required. Responsible for supervising hospice aides.
5. Excellent observation, verbal and written communication skills, problem-solving skills, basic math skills; nursing skills per competency checklist.
6. Prolonged or considerable walking or standing. Able to lift, position, and/or transfer patients. Able to lift supplies and equipment. Considerable reaching, stooping bending, kneeling, and/or crouching. Visual acuity and hearing to perform required nursing skills.
7. Must be a licensed driver with an automobile that is insured in accordance with state/or organization requirements and is in good working order.

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this job, the employee is frequently required to sit or stand. The employee must occasionally lift and/or move up to 50 pounds.

Luminary Hospice is an equal opportunity employer and is committed to creating a diverse and inclusive workplace. We do not discriminate against any applicant or employee based on race, color, religion, gender, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, genetic information, or any other characteristic protected by federal, state, or local laws. We are committed to providing a work environment free from discrimination and harassment, where all individuals are treated with respect and dignity. All employment decisions at Luminary Hospice are based on business needs, job requirements, and individual qualifications.

Luminary Hospice offers a competitive compensation package, along with a comprehensive benefits package that includes health, dental, and vision insurance, retirement savings options, and more. Our benefits are designed to support your health, well-being, and long-term financial goals.