Goals of Care Nurse
- Circle Home
- Job ID
- Full Time
The Goals of Care Nurse works with identified patient populations including acute, chronic, and life limiting disease process to identify and support patient goals. During skilled assessment visits, the Goals of Care Nurse has an in depth patient centered conversation to identify needs and provides education of different levels of homecare to support patients goals. It is the responsibility of the goals of care nurse to communicate and collaborate with internal and external providers to support patient’s needs.
- Provide comprehensive care that is consistent with the patient’s social, emotional, cultural, and physical needs.
- Collaborate with all levels of homecare to support patient goals.
- Strong ability to identify patients that would benefit from Hospice evaluation and discussions about care and comfort level of care.
- Support patient centered goals; assist with transitioning patients to palliative and hospice as appropriate.
- Effectively review documentation to identify patient needs.
- Work with external referral sources to educate, provide in-services, and provide support to collaborate care of patient populations.
- Active RN licensure in Massachusetts, New Hampshire and Maine or willingness to obtain both required.
- Prior Case Management experience required
- Prior Home care experience including palliative/hospice required