LVN Case Manager - Palliative

San Diego’s St.

Paul's PACE program (Program of All-Inclusive Care for the Elderly). This innovative program is for individuals 55 years or older, who are living with chronic illness, or disabilities and need coordinated medical care to continue living as independently as possible in their home and community.

The healthcare teams at St.

Paul’s PACE provide a hands-on approach coordinating medical, social, and home care services so individuals no longer need to manage their medical care alone. 
 

Job Summary: Under the direction and supervision of the End of Life and Palliative Manager, the Palliative Case Manager LVN plans, organizes and coordinates palliative care services.

The nurse demonstrates detailed nursing assessments skills, including a comprehensive nursing evaluation and interaction with participants as needed in their home environment.

Participates in planning, executes interventions in accordance with the goals of care and contributes to the evaluation of individualized interventions related to the goals of care.

Coordinates with the interdisciplinary team to develop a comprehensive goal of care for each client.

Administers medications, implements primary care orders, and evaluates participant complaints physically or by phone and report findings to the physician.

Provides education to participants and caregivers in regard to goals of care, nursing treatments or medications.

Communicates participant’s condition to primary care givers, physician and multidisciplinary team. 

Duties and Responsibilities: 
Patient Care 


* Completes an initial and ongoing comprehensive evaluation of patient and family to determine palliative needs.

Provides a complete physical evaluation and history of current and previous illness(es).


* Provides professional nursing care by utilizing all elements of nursing process and as defined in the state Nurse Practice Act.


* Evaluates patient’s status by regularly re-evaluating patient and family/caregiver needs, and participating in revising the goals of care as necessary


* Administers medications and treatments as prescribed by the physician in the physician’s plan of care.


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


* Provides health care instructions to the patient as appropriate.


* Assists the patient with working toward self-sufficiency and optional comfort care.


* Acts as Case Manager as assigned and assumes responsibility to coordinate patient care for assigned caseload. 

Communication 


* Completes, maintains and submits accurate and relevant clinical notes regarding patient’s condition and care given.

Records pain/symptom management changes/outcomes as appropriate.


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


* Teaches the patient and family/caregiver self-care techniques as app...