Registered Nurse Case Manager

PRIMARY FUNCTION
The VITAS RN is a member of the interdisciplinary team who work together to meet the
physical, medical, psychosocial, emotional and spiritual needs of hospice patients and families
facing terminal illness and bereavement. The VITAS RN is designated to provide coordination of
care, ensure continuous assessment of each patient’s and family’s needs, initiates interventions
for patients and families and implementation and oversight of the interdisciplinary plan of care.

JOB RESPONSIBILITIES
Follows VITAS policies and standards (See VITAS Standards Manual) and practices within the
scope of the RN license and has knowledge of hospice eligibility requirements.
Case Management and Supervision
 Coordinates all service delivery including review of entries in the record made by after hours,
patient and family education, dispatching of interdisciplinary visits, and coordination of services
with external vendors and resources as needed.
 Provides support and collaboration with IDG and after hours staff to ensure favorable patient
outcomes.
 Supervision of (VITAS employed and contracted) nursing tasks delegated to Hospice Aides,
Licensed Practical/Vocational Nurses (and contracted Registered Nurses) and Volunteers per the
plan of care.
 Reports any request to practice outside of scope of license to the manager/supervisor.
 Documents interactions with patients, families, contacts, and vendors in the patient record to
include the assessment, plan of care, caller agreement to the plan, any actions and interventions
and the resolution of each patient/family interaction at the time of the event.
 Completes in person visit documentation at the location of care unless otherwise directed.
 Provides education and training to patients, families, caregivers and referral sources in the care of
the patient, including pain management.
 Participates in patient care meetings as assigned.
 Participates in bereavement support.
 Participates in the on-call rotation and/or provides shifts during non-business hours such as
evenings, weekends and holidays based upon identified needs.
 Provides visits /shifts in program coverage area.
 Works with IDG to develop, coordinate, and follow the patient’s individualized plan of care.
 Obtains physician orders when necessary.
 Provides those services requiring substantial and specialized nursing skill.
 Evaluates the outcome of services.
 Appropriately delegates nursing tasks to Hospice Aides/Homemakers, Volunteers, and
Licensed Practical/Vocational Nurses.
 Connecticut –For activities other than those listed in section 19-13D69(d)(3) of the

Connecticut Department of Public Health delegated to a Hospice/Homemaker, the RN
will document in the clinical record that:
i. All factors pertinent to the patient’s safety, including the competence of the
Hospice Aide/Homemaker have been assessed.
ii. Determination that this activity can be delegated safely to a Hospice
Aide/Homemaker.

 Provides nursing care including nursing tasks that may be delegated to other roles such as
LPNs, HAs and Volunteers.
 Participates in and monitors patient and family care compliance activities.
 Professionally manages/coordinates the hospice plan of care.
 Provides and follows infection control practices.
 Delivers care in accordance with the patient’s plan of care.
 Provides primary nursing care for inpatient and continuous care patients as assigned.
 Participates in the orientation of new team members as assigned by the supervising manager.
 Attends regularly scheduled in-services, staff meetings, and educational conferences.
 Instructs and documents appropriate use of medications, home medical equipment and supplies.
 Appropriately utilizes the resources such as Pharmacy, HME, agency staff, and transportation
services.

Quality Improvement
 Participates in the Quality Assessment and Performance Improvement (QAPI) Program and
related activities as assigned. This may include, but is not limited to participation in
Performance Improvement Project(s) (PIP).
 Gathering clinical data which is used for quality measures.
Professional Development
 Develops and achieves professional growth goals and objectives personally and per Team
Manager reviews.
 Responsible for attending orientation and regularly scheduled in-services/educational
conferences as assigned.
 Participates in orientation of Hospice Aides, Volunteers and other IDG members as assigned.
 Participates in training activities internally within VITAS and externally as assigned.
 Seeks certification in the specialty of hospice nursing when qualified to do so.
Customer Service
 Maintains focus on the patient and family experience of care.
 Serves as a patient and family advocate.
 Reports patient/family/customer complaints to Team Manager.
 Participates in patient/family/customer conflict resolution as applicable.
 Represents the nursing profession, the VITAS site/location and VITAS overall in a positive
manner.
 Serves as the patient and family advocate by communicating with the attending physicians, long
term care facility staff, case managers, and others external to VITAS as necessary.
 Promotes a customer service-oriented approach to care delivery.
This position description in no way states or implies that these are the only duties to be performed by
the employee occupying this position. Employees will be required to perform any other job duties
assigned by their supervisor or management.

JOB REQUIREMENTS
 In order to see patients in-person must have reliable transportation to be used for work with
adequate insurance coverage for driver and passengers as applicable.
 Cellular Telephone available.

ESSENTIAL FUNCTIONS/PHYSICAL DEMANDS
The physical demands described in this job description are representative of those that must be
met by an employee to successfully perform the essential functions of this job.
While performing the duties of this of seeing patients in-person, the employee is regularly
required to:
 Assist in lifting and transferring patients, as required.
 Lift objects in excess of 20 pounds.
 Sit, stand or walk in excess of one hour per day.
 The employee will be required to sit and stoop, kneel, and crouch.
 Talk hear, and have visual abilities including close vision, distance vision, and the ability
to adjust focus.

QUALIFICATIONS
 Currently licensed to practice nursing in the state where the VITAS program/patient is
located.
 A minimum of one year of nursing experience.
 Equivalent experience or licensure may be considered.
 Ability to work as a team player and multi-task.
 Proficient in customer conflict resolution and crisis management.
 Thorough knowledge of professional nursing principles, methods and procedures; anatomy and
physiology; medical supplies and equipment used in nursing practice; and the uses and effects of
medications including narcotics.
 Working knowledge of applicable state and federal laws and regulations pertaining to registered
nursing and the scope of practice limitations of clinic support staff.
 Ability to work weekends and holidays as necessary to support the operations of the Care
Connection Center.

ADDITONAL QUALIFICATIONS TO PROVIDE AFTER HOURS TRIAGE
 One year of customer service/call center experience preferred.
 Eligible for licensure in other states VITAS Triage services are located.
 Excellent verbal, written, and interpersonal communication skills, as well as demonstrated
effective telephone skills.
 Ability to type 40 WPM.
 May be required to obtain additional nursing licenses, based on business needs.

EDUCATION
 Graduate from an accredited school with an associate or bachelor’s degree in Nursing.

ACCOMMODATIONS
Reasonable accommodations may be made to enable individuals with disabilities to perform the
essential functions of the job.

DIRECTION RECEIVED
Reports directly to the Team Manager.