RN Case Manager

BETHESDA AT HOME

HOSPICE RN CASE MANAGER JOB DESCRIPTION

Job Summary:
 The Hospice RN Case Manager is responsible for providing, coordinating, and monitoring comprehensive end-of-life care for hospice clients in accordance with agency policies and federal/state regulations. Ensures safe, compassionate, and individualized care that supports quality of life, patient dignity, and family involvement.

Job Relationships:

• Reports to: Hospice Director (or designated Hospice Administrator)
• Supervisory Responsibilities: Hospice Aides
• Internal Relationships: Other Hospice RNs, Scheduler, Social Workers, Chaplains, Volunteers, Medical Director, IDG team
• External Contacts: Physicians, Pharmacists, Home Health Agencies, Nursing Homes, Hospital Discharge Planners, Clients, Families, and Community Partners

Hours of Work:

This is currently a part-time position, with flexible scheduling based on client needs.
Potential for full-time hours, depending on census and agency needs.
 Includes rotating on-call and weekend duties as assigned.

Dress Code:

Professional attire or nursing uniform with agency identification badge.

Essential Requirements:

1. Education & Licensure:

• Graduate of an accredited nursing program.
• Current Minnesota RN license.

2. Experience:

• Minimum 1 year of nursing experience, preferably in hospice, palliative, oncology, or geriatric care.
• Strong clinical assessment and symptom management skills.
• Basic computer proficiency.

3. Personal Qualifications:

• Excellent communication (oral/written) and organizational skills.
• Compassionate, self-motivated, and team-oriented.
• Ability to provide emotional support to families.
• Valid driver’s license, insured vehicle.

4. Knowledge Base:

• Understanding of the dying process and hospice philosophy.
• Familiarity with CMS Conditions of Participation for Hospice.
• Knowledge of pain and symptom control techniques.
• Documentation and care planning experience.
• Infection control, HIPAA compliance, and quality standards.

Physical Demands:

• Frequent driving, bending, squatting, and lifting (25+ lbs).
• Exposure to infections in home and facility settings.

Key Responsibilities:

1. Clinical Care Management:

• Perform initial, comprehensive, and ongoing nursing assessments.
• Develop and implement individualized hospice care plans in collaboration with IDG.
• Manage and coordinate symptom control (e.g., pain, dyspnea, nausea).
• Provide skilled nursing care and guidance to clients and families.
• Educate families on care techniques and the dying process.
• Facilitate advance care planning and understanding of services.

2. Interdisciplinary Collaboration:

• Participate in IDG meetings, ensuring effective coordination of care.
• Communicate timely updates with physicians and care team.
• Coordinate services with hospice aides, social workers, chaplains, and volunteers.

3. Supervision & Oversight:

• Supervise hospice aide services with routine home visits.
• Provide coaching and feedback to hospice aides.
• Ensure aide care plans are up to date and services meet patient needs.

4. Emergency & On-Call Coverage:

• Participate in rotating on-call schedule.
• Respond to urgent calls, assess, and intervene as necessary.
• Document on-call communications and visits.

5. Documentation & Compliance:

• Maintain timely and accurate documentation in EMR.
• Complete all required assessments, care plans, and visit notes.
• Ensure compliance with hospice regulations (e.g., HIS, IDG notes, certifications).
• Submit documentation to physician and DME/pharmacy providers as needed.

6. Family and Community Support:

• Provide emotional support and grief resources to families.
• Serve as a liaison between family, hospice, and other providers.
• Support families through active death and post-death care coordination.

7. Education and Growth:

• Attend mandatory in-services and annual competencies.
• Participate in agency quality improvement initiatives.
• Promote hospice services through professional, compassionate representation.