*Candidate must be bilingual in Spanish
Provides case management and coordination of care for assigned hospice caseload. Provides and documents skilled nursing service to patients and families in their home/communities within established hospice and company philosophy and standards. Follows all organizational policy, procedure and performance standards. Demonstrates strict adherence to HIPAA compliance regulations and HIPAA related policies. Maintains confidentiality of all patient identifiable medical information.
CASE MANAGEMENT 30%
Utilizes the nursing process and holistic approach to appropriately case manage and coordinate patient/family care.
a.) Assesses patient and family unit’s physical (with particular attention to pain and other distressing symptoms of dying), psychosocial, dietary, environmental, spiritual and financial needs relative to Hospice Care.
b.) Develops, plans and coordinates an individualized patient/family plan of care with the input of the Interdisciplinary Hospice Team and attending physician..
c.) Implements the Plan of Care (POC) which includes patient/family support, education and initial bereavement plan.
d.) Involves client and caregiver(s) in the development and adjustment of the POC.
e.) Evaluates the effectiveness or outcomes of POC, notifies physician of change in client’s status and coordinates for any adjustment of the POC.
f.) Collaborates with other disciplines and appropriately refers for other disciplines to accomplish optimal outcomes, goals and services, as needed.
g.) Consults with, and educates the patient and family, regarding the disease process, symptom management, self-care techniques and prevention strategies.
h.) Initiates appropriate preventative and rehabilitative nursing procedures.
i.) Informs the physician and other personnel of changes in the patient/family’s needs.
Fiscal Accountability 20%
a.) Maintains and exceeds organizational productivity standard.
b.) Follows organizational protocol for ordering patient specific supplies.
c.) Utilizes resources appropriately.
d.) Incorporates reimbursement requirements/guidelines into the case management, i.e., Medicare, Medicaid and managed care requirements.
e.) Maintains responsible pattern of work attendance and promptness.
f.) Develops and maintains organizational and time management skills.
g.) Schedules patient’s visits appropriately given patient /family needs and notifies patients/families in advance of visits to minimize absent visits.
h.) Complies with managed care reporting/authorization process to ensure reimbursement for services rendered.
i.) Ensures that the case management skills and nursing processes are employed effectively for efficient/outcome driven plan of care.
a.) Maintains or exceeds organizational standards for timeliness of documentation submission
b.) Maintains or exceeds organizational standards for following format, content and accuracy of clinical documentation.
c.) Ensures that the content of documentation is clear, relevant, and descriptive of the course of care.
Communication/ Customer Service 15%
a.) Participates as an active member of the Hospice Interdisciplinary Team.
b.) Demonstrates working knowledge of “who” (internal & external) the customers are.
c.) Provides written, oral and non-verbal communication to all customers that is prompt, clear, respectful, helpful and effective.
d.) Acts to “own” a call, concern or problem to its fullest.
e.) Acts as an organizational system liaison for client and family unit in commu
nication/coordination with health care team.
f.) Acts as a translator of organizational, reimbursement and clinical information to clients.
g.) Reviews clients rights/responsibilities, POC and DC plan on a regular basis.
Personal/Professional Growth and Development 15%
a.) Maintains all necessary requirements for licensure.
b.) Attends all required inservice training, c
ertification and competency training.
c.) Participates in organizational committee work as appropriate.
d.) Assists in precepting new staff as appropriate.
e.) Seeks outside education and certification.
All other duties as assigned 5%
a.) Demonstrates strict adherence to HIPAA compliance regulations and HIPPA related policies. Maintains confidentiality of all patient identifiable medical information.
b.) Specialized duties/ responsibilities including on-call responsibilities as dictated by hospice patient/family needs.
Age of Patients Serviced
Not applicable Neonates Pediatric
x Adult x Geriatric x All
Lifting Capabilities (must equal 100%) 0-10 lb % of time 25
10-50 lb % of time 50
Over 50 lb % of time 25
Check if required
x Ability to reach above head x Lengthy standing
Moderate standing x Intermittent walking
Moderate walking Continuous walking
x Ability to twist upper body
x Ability to manually manipulate equipment/utensils
x Ability to drive automobile
x Ability to climb stairs
x Ability to wear respiratory apparatus
RISK OF EXPOSURE TO HAZARDOUS MATERIALS
____NONE x____ MODERATE EXPOSURE _____HIGH EXPOSURE
RISK OF EXPOSURE TO BLOODBORNE PATHOGENS
____NONE _____MODERATE EXPORSURE x____HIGH EXPOSURE