RN Case Manager - Facilities Team M-F 8a-5pm

Job Details

Job Location:

Spicewood - Austin, TX 78759

Position Type: 40 HRS - 1 FTEJob

Shift: M-F 8A-5

PDEPARTMENT:
Clinical Services

REPORTS TO:

Team Leader

SUPERVISES:
None

POSITION SUMMARY:

The hospice RN provides comprehensive, professional nursing care to patients in both homecare and assigned facility settings, including conducting admissions visits for new patients and delivering ongoing education to facility staff. The role includes performing thorough initial and ongoing assessments, developing and updating individualized plans of care, managing symptoms, and offering psychosocial and end of life support to patients and families.

The nurse consults with and educates caregivers and facility partners on disease processes, comfort measures, and hospice philosophy, ensuring consistent, high quality care across settings. Using a case management approach, the RN coordinates all aspects of patient care such as bath aide services, DME, medications, and interdisciplinary referrals while maintaining timely, accurate documentation in both agency and facility records. The nurse collaborates closely with physicians, interdisciplinary team (IDT) members, hospital and facility staff, and other care partners to communicate changes in condition, support discharge planning, and facilitate smooth transitions of care.

The role includes supervising CNAs, LVNs, and homemakers, maintaining professional boundaries, and practicing effective self care to sustain high quality clinical performance.

• Provides professional nursing care for hospice patients in the homecare and assigned facility settings.
• 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, including any risk for pathological grief, cultural and spiritual implications, and verbal and non verbal communication patterns.
• Performs comprehensive nursing assessments, including vital signs, pain assessment, breath sounds, and other clinically indicated evaluations.
• Triage patient care concerns and determines appropriate interventions.
• Initiates preventive, comfort focused, and rehabilitative nursing procedures as needed and facilitates transition to another level of hospice care when appropriate.
• Develops, maintains, and updates individualized plans of care, performing specialized nursing skills related to palliative and end of life care, symptom management, and comfort measures.
• Consults with and educates patients and caregivers, including hospital, alternate living facility, or home health staff, regarding disease process, self care techniques, end of life care, comfort measures, medication use and side effects, and ethical considerations. Provides specialized training to staff and/or caregivers to ensure adequate and safe care.
• Performs ongoing evaluation of patient and family response to care and adjusts interventions accordingly.
• Provides psychosocial support to patients and families throughout the course of care.
• Provides preparation and support for the patient’s death; pronounces death in accordance with state regulations, provides postmortem care, and handles the body and death event with respect, dignity, and in accordance with patient/family/caregiver wishes.
• Utilizes proper infection control and bag technique during all in person visits.
• Reports adverse events (complaints, infections, falls) to the Team Leader or Quality Department as soon as possible but no later than 24 hours of obtaining information.
• Performs point of service documentation and completes/signs all documentation according to agency protocol.
• Complies with minimum weekly visit requirements per company protocol.
• Conducts admissions visits for new patients in assigned facilities, completing initial comprehensive assessments, initiating the plan of care, and ensuring a smooth transition onto hospice services.
• Provides ongoing education in assigned facilities, including training for facility staff on hospice philosophy, symptom management, communication expectations, and care coordination processes.
• Coordinates nursing, personal, and homemaker…