The Registered Nurse Case Manager, as a member of the interdisciplinary team, is responsible for the provision of skilled nursing assessment, planning and provision of patient care in order to maximize the palliation of symptoms. In addition, the nurse case manager is responsible for identifying patient or family needs and providing supportive care and appropriate services in accordance with the attending physician’s orders, the interdisciplinary team plan of care, and the policies and procedures of the agency. Skills / Requirements
1. Be eighteen (18) years of age or older
2. Minimum associate degree in nursing from an accredited school
3. Possession of a current license to practice in the State of New Mexico as a registered nurse.
4. Demonstrated skill in nursing practices and clinical judgments
5. Ability to cope with family emotional stress and tolerance of individual lifestyles
6. Understanding of the hospice philosophy and the ability to assess and manage symptoms
7. Must have a valid NM Driver’s license
8. Must have reliable transportation available during work hours. Vehicle must be properly registered and insured in accordance with state law.
9. Must possess current CPR Certification
DUTIES AND RESPONSIBILITIES:
1. Assume primary responsibility for patient and family caseload, including the assessment, planning, implementation and evaluation phases of the nursing process.
2. Obtain data on physical, psychological, social and spiritual factors that may impact patient and family’s needs and initiate intervention by other members of the interdisciplinary team.
3. Initiate communication with the attending physician, other interdisciplinary staff members and other agencies for the purpose of coordinating optimal care.
4. Effectively utilize resources to assist in meeting the patient’s needs.
5. Provide regular visits to re-assess the patient’s needs and update the plan of care.
6. Perform therapeutic, preventative and rehabilitative nursing procedures as directed by the attending physician.
7. Perform clinical pronouncement of death and provide support to family
8. Perform initial assessment of individuals referred for care, determine eligibility under Ambercare criteria and perform admission of the patient.
9. Maintain an accurate clinical record through the timely preparation of care plans and clinical and progress notes.
10. Maintain regular communication with all members of the interdisciplinary team, alerting physician and nursing supervisor to any changes in the patient’s condition or needs as well as potential problems or issues.
11. Provide effective teaching to family, caregivers and interdisciplinary team members to ensure continuity of care for the patient.
12. Develop and maintain familiarity with Federal, State, CHAP, and Ambercare policies and procedures regarding patients benefit.
13. Supervise and document delivery of care by the Home Health Aide as required by Federal, State, CHAP, and Ambercare guidelines.
14. Attend care conferences for the purpose of coordinating care for patients in nursing or residential care facilities.
15. Supervise and assess the delivery of care by the licensed practical nurse.
16. Share in providing 24 hour, 7 day per week coverage to patients and families as necessary.
17. Accept responsibility for professional growth and development through participation in continuing education programs, agency in-services and community events.
18. Adhere to dress code
19. Adhere to work schedule and maintain good punctuality and attendance record