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American Hospice and Home Health Care

Hospice Registered Nurse (RN) Case Manager - Solano County

American Hospice and Home Health Care, Vallejo, California, United States, 94592

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Hospice Registered Nurse (RN) Case Manager – Solano County American Hospice and Home Health Services is currently seeking a Part Time RN to service either one or a combination of these counties: Solano County, Contra Costa County. Pay is negotiable depending on experience: $50‑$65 per hour or $100‑$200 per visit.

Essential Job Functions / Responsibilities A. Assessment

1. Assesses physical, functional, psychosocial, and cognitive status of the home care patient utilizing interview observations and physical exam techniques.

2. Assesses the home environment for safety, infection control, and community resource needs.

3. Collects information for assessment with the patient, family, physician and other health care team members.

4. Incorporates multidisciplinary data into the nursing assessment of the home care patient.

5. Provides ongoing nursing assessment with the patient, family and home environment to determine physiologic or psychosocial risk. Applies previous nursing experience and base of knowledge and adapts with the patient and family in a home setting.

6. Assesses for the presence of advanced directives and facilitates further action in obtaining information about or implementing advanced directives if indicated.

B. Planning

1. Plans with the patient, family and physician for care which is feasible within the physical, financial and emotional resources of the family.

2. Establishes individualized, measurable goals in consultation with the patient, family and other health care providers.

3. Anticipates home care needs and seeks a wide range of community resources to facilitate problem solving.

4. Develops standards of care for patients in the home setting.

5. Utilizes home care standards and regulatory guidelines in developing an individualized care plan with each patient and family.

6. Maintains a working knowledge of community resources and refers patients and families appropriately.

C. Implementation

1. Provides skilled nursing care, preventative rehabilitative procedures, and prescribed treatments with a variety of patient populations within various potentially complex home situations.

2. Maintains technical skills according to agency standards, as measured by competency assessments during orientation and annually.

3. Implements safe, competent care with home care patients and families within the Home Health Agency’s system.

Documentation and Communication

1. Maintains a complete record for the care that is given with the patient, documenting in the clinical record per agency policy and procedure.

2. Maintains an updated clinical record on each patient at all times, meeting required deadlines for certification, re‑certification, aide supervision reports, aide care plan updates, routine recording of case coordination, care plan updates, progress toward goals, and verbal orders.

3. Accurately completes admission and revisit documentation, communication documentation, billing and employee statistical information, and payroll documentation.

4. Documents regular contacts with payers.

5. Documents patient, family and caregiver teaching.

6. Prepares clinical notes and updates the primary physician when necessary and at least every 60 days.

7. Communicates with the physician regarding the patient’s needs and reports any changes in the patient’s condition; obtains/receives physician’s orders as required.

8. Communicates with community health‑related persons to coordinate the care plan.

Clinical Care and Case Management

1. Completes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illness(es).

2. Regularly re‑evaluates patient nursing needs.

3. Initiates the plan of care and makes necessary revisions as patient status and needs change.

4. Uses health assessment data to determine nursing diagnosis.

5. Develops a care plan, which establishes goals based on nursing diagnosis and incorporates therapeutic, preventive, and rehabilitative nursing actions. Includes the patient and the family in the planning process.

6. Initiates appropriate preventive and rehabilitative nursing procedures. Administers medications and treatments as prescribed by the physician.

7. Counsels the patient and family in meeting nursing and related needs.

8. Provides health care instructions to the patient as appropriate per assessment and plan of care.

9. Identifies discharge planning needs as part of the care plan development and implements prior to discharge of the patient.

10. Acts as Case Manager when assigned by Clinical Supervisor and assumes responsibility to coordinate patient care for assigned caseload.

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. Instructs, supervises and evaluates home health aide care provided every two (2) weeks.

Licenses Required

1. Current RN License in State of California.

2. Minimum 1 year experience as a professional nurse within the last three years in public health, home care or hospice nursing.

3. Current CPR certification.

4. Licensed driver with an automobile insured per state/or organization requirements.

Compensation Details $50‑$65 per hour and $100‑$200 per visit.

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