Job Profile Summary 

​This role focuses on providing professional and nonprofessional nursing care services in accordance with physician orders.  In addition, this role focuses on performing the following Home Care Nurse duties: Assesses, plans, implements, and evaluates the care needs of a designated group of patients or provides nursing care and identified clinical support tasks within the scope of practice for achievement of the patient’s plan of care as directed.  Provides professional nursing care to patients. Requires a nursing license.   A professional individual contributor role that may direct the work of other lower level professionals or manage processes and programs.  The majority of time is spent overseeing the design, implementation or delivery of processes, programs and policies using specialized knowledge and skills typically acquired through advanced education.   A role that supervises all levels of employees.  Responsibilities that typically include: Setting goals and objectives for team members for achievement of operational results, problems faced may be difficult but typically are not complex, and ensures policies, practices and procedures are understood and followed by direct reports, customers and stakeholders. 

Job Overview 

This position implements and oversees the Home Health Foundation Palliative Care Team and Hospice team. Assumes a leadership role with clinical staff to ensure that best practices are followed. Works cooperatively with VNA, palliative care, and hospice teams, as well as physicians, referral sources and the referral department so that patients meeting established criteria are identified for palliative care services, goals of care conversations, health coaching or a transition to hospice, ensuring that patients are receiving the right level of care at the right time. 

Job Description 

Minimum Qualifications: 

1. Bachelor’s degree in Nursing (BSN). 

2. Candidates must hold an active RN license in the state where services are provided and may not work in states where they are not licensed. If additional state licensure is required, it must be obtained within sixty (60) days

3. Five (5) years of palliative, hospice, complex care experience. 

4. Home care experience. 

Hours: Full-Time, 40hrs/week

Location: Lowell, MA

Duties and Responsibilities: The duties and responsibilities listed below are intended to describe the general nature of work and are not intended to be an all-inclusive list.  Other duties and responsibilities may be assigned. 

1. Monitors and evaluates palliative care and hospice patient population census, trends, processes and outcomes.   

2. Develops, implements and monitors clinical protocols to achieve desired outcomes promoting palliative care and hospice philosophy, holding staff accountable to current clinical standards of palliative and hospice practice and policies and procedures.  

3. Promotes and maintains full implementation of the palliative care and hospice programs. Develops/revises program-specific policies and procedures as needed.  

4. Communicates with appropriate individuals regarding the palliative care and hospice programs, i.e. Medical Directors, hospital personnel, vendors, director, managers and staff to ensure optimal care. 

5. Ensures staff are aware of the palliative care and hospice programs by actively promoting and training staff through ongoing activities such as individual outreach, care management activities, attendance at team meetings, etc.  

6. Develops and implements Standards of Practice in collaboration with the Director of Hospice and Palliative Care. 

7. Develops and updates weekly, monthly and program reports. Utilizes data to manage costs and outcomes.  

8. Works cooperatively and collaboratively with team members to address individual clinician competency toward the palliative care and hospice clinical protocols, best practice standards, and other processes and outcomes.   

9. Develops effective relationships with referral sources.  

10. Works with UR to ensure availability of documentation and information needed for payment. Approves only invoices related to the delivery of hospice care. 

11. Reviews plan of care with clinicians and ensures primary physician is updated adequately and assists with obtaining orders from physicians as indicated.  

12. Conducts random chart audits.  Follows through on any areas that appear to be deficient or incorrect according to the Palliative regulations, Hospice conditions of participation, and agency policies. 

13. Provides Documentation to Meet Patient Needs, Legal and Reimbursement Requirements, and Other Agency Requirements.   

14. Arranges for coverage when not available including providing a detailed report to the covering clinician and obtaining a report from the covering clinician. 

15. Manages palliative and hospice clinicians as well as ancillary staff to assure program and agency goals are met.  

16. Utilizes team building skills and problem solving to promote optimal team performance and effectiveness. Directs and ensures completion of orientation of new staff. 

17. Assesses staff education needs, provides training, provides day-to-day supervision, delegates appropriately, and provides constructive feedback and takes disciplinary action to members of the team when necessary. 

18. Evaluates palliative care and hospice staff according to policies, procedures and position requirements. When appropriate, recommends merit increases and staff assignment according to staff performance.  

19. Communicates effectively and maintains positive working relationships with other members of the health care team, administration and other departments. Educates clinicians on protocols for care. 

20. Maintains effective working relationships with patients, families and referral sources.  

21. Participates in case conferences and participates in/facilitates Interdisciplinary Team Meetings and facilitates 

22. Develops and implements systems to assess patient and physician satisfaction with service. 

23. Reports Compliance concerns to the CEO or Chief Compliance Officer when applicable. 

24. Ensures compliance within guidelines set forth by regulatory agencies (JCAHO, DPH, ERISA, etc.) and demonstrates compliance with Home Health Foundation policies and procedures.  

25. Ensures Program services meet the agency’s objectives. 

26. Monitors utilization of resources and related costs to achieve desired outcomes. 

27. Evaluates the programs’ need for data collection and sets up systems to acquire and maintain information. 

28. Documents findings and actions taken. 

29. Identifies trends and makes recommendations. 

30. Maintains statistics and generates reports on programs to meet outcomes. 

31. Assures that the palliative care and hospice staff complete all appropriate documentation needed for submission for compliance. 

32. Ensures the delivery of quality care by reviewing referrals to determine most appropriate initial course of action, promoting service excellence, maintaining team productivity, and ensures contribution from all members of the IDT in the delivery of hospice care for each patient. 

Physical Requirements:  

1. Standing and walking for extensive periods of time. 

2. Occasionally requires lifting and carrying items weighing up to 10 pounds. 

2. Frequent exposure to hazardous chemicals, sick patients, bodily substances, noise and possible exposure to radiation, lasers, electric shock, etc. 

5. Regularly exposed to the risk of bloodborne diseases and other transmissible infections. 

6. Contact with patients under wide variety of circumstances. 

7. Subject to varying and unpredictable situations. 

8. Ability to handle emergency and crisis situations. 

9. Subjected to irregular hours. 

10. May have contact with hazardous materials. 

Skills & Abilities: 

1. Demonstrates knowledge of CQI processes. 

2. Excellent interpersonal skills.  

3. Ability to function well in busy situations and work in a matrix organizational structure. 

4. Responsible and reliable. 

5. Strong organizational, and verbal and non-verbal communication skills. 

6. Critical thinking and problem-solving capability. 

At Tufts Medicine, we want every individual to feel valued for the skills and experience they bring. Our compensation philosophy is designed to offer fair, competitive pay that attracts, retains, and motivates highly talented individuals, while rewarding the important work you do every day.

The base pay ranges reflect the minimum qualifications for the role. Individual offers are determined using a comprehensive approach that considers relevant experience, certifications, education, skills, and internal equity to ensure compensation is fair, consistent, and aligned with our business goals.

Beyond base pay, Tufts Medicine provides a comprehensive Total Rewards package that supports your health, financial security, and career growth—one of the many ways we invest in you so you can thrive both at work and outside of it.

Pay Range:

based on full-time equivalent