Case Manager-Palliative Care

Job Summary

The Palliative Care Case Manager will provide care coordination, care transition management, palliative care and other services to patients with life-limiting, late-stage chronic illnesses.  Working within the established medical plan of care, the Palliative Care Case Manager will work with the patient and family to identify goals of care that reduce the severity of disease symptoms and maximize the quality of life. Utilizing a multidisciplinary team approach, the Palliative Care Case Manager will facilitate meeting physical, emotional, and spiritual needs.

Minimum Qualifications

Minimum Education: Bachelors in Nursing Degree
Minimum Years of Experience: 5 Years of experience as a registered nurse in an acute hospital setting
Substitutable Education & Experience (Optional): None.
Required Certifications/Licensure: Currently licensed as Registered Nurse by the State Board of Nursing for South Carolina;

Certification in Palliative Care required within 18 months of hire.
Required Training: None.

Essential Functions

• Works in a cooperative manner, which fosters favorable relations between employees and patients, patient’s families, visitors, fellow employees and the medical staff. Accepts chain of command, supervision and constructive criticism.
• Exhibits commitment and pride through person example.
• Contributes to teamwork and creates harmonious, effective and positive working relationships with others
• Respects, understands and responds with sensitivity to employees and guests by treating others as one would wish to be treated.
• Resolves conflicts and problem-solves.
• Exhibits telephone courtesy.
• Maintains Confidentiality.
• Facilitates the delivery of quality, cost-effective patient care and the achievement of desired outcomes for patients, families, and the organization through the coordination of services and the provision of direct patient care as needed.
• Working within the medical plan of care, supports patient / family to identify desired outcomes for managing life-limiting or terminal illness.
• Co-ordinates patient care conferences with the physician and other members of the health care team as needed.
• Reinforces information to patient and family as needed.
• Focuses on pain management and alleviation of symptoms.
• Involves professionals of other disciplines as needed to provide information, education and expertise in managing symptoms.
• Supports patient / family at critical decision points in care.
• Acts as a liaison with community physician, home health agency staff, or others involved in the patient’s ongoing care.
• Communicates with payor’s case managers when available to facilitate continuity of care across the continuum.
• Conducts rounds on patients when hospitalized.
• Monitors for readmission and intervenes at earliest opportunity.
• Makes follow up phone calls after discharge to ensure appropriate services are in place.
• Demonstrates competence to evaluate developmentally-appropriate clinical care for the following patient populations:
  • a. Adult (years 18 – 65)
  • b. Geriatric (over 65 years)

Duties & Responsibilities

• Functions as a patient advocate.
• Embodies those behaviors, philosophies and values, which serve to uphold the ideals and enhance the image of Lexington Medical Center (LMC).
• Models LMC philosophy, standards of care, standards of practice, policies, procedures, and protocols.
• Demonstrates receptiveness to change and flexibility in meeting department needs.
• Meets all mandatory education requirements of hospital.
• Acquires appropriate continuing education for own professional development (Minimum of 25 hours per year).
• Participates in professional organizations/ activities pertinent to areas of specialty.
• Assists in educating unit staff and other members of the health care team regarding palliative care.
• Enhances understanding of the role of Palliative Care Case Management through availability and interaction with patients, families and other health care professionals.
• Promotes high standards of care and practice.
• Establishes and fosters a networking relationship within the organization.
• Seeks and provides consultation with other health care team members.
• Demonstrates efficient use of electronic communication and various computer software products.
• Acts as a resource person to physicians for palliative care services.
• Represents department on various committees/taskforces.
• Assist in the identification of opportunities for improvement in patient care, health care practice and interaction with health care team, and initiate and/or participates in development of action plans to achieve desired outcomes.
• Participates in and contributes to departmental governance process and supports effective operation of the department.
• Participates on performance improvement teams/ task forces/ committees.
• Participates in the identification of customer needs and expectations.
• Utilizes available resources and appropriate administrative and organizational channels to facilitate improvement activities.
• Utilizes and maintains information in manner which is organized and efficient.
• Utilizes nationally-developed practice guidelines and other research-based practice recommendations in the selection of the process and outcome indicators to be measured.
• Maintains required records/reports.
• Meets all requirements as defined by the policies of the organization.
• Completes yearly safety training and other mandatory classes.
• Completes employee health workup.
• Performs all other duties as assigned by authorized personnel or as required in an emergency (e.g., fire or disasters).