Palliative Care Registered Nurse / Linda Vista / FT (464)

Sharp Community Medical Group • Full-time • San Diego, California, United States • 1w ago

Job Title: Palliative Care Registered Nurse (Monday- Friday; 8AM-5PM)

Location: Linda Vista

Job Type: Full Time
Salary Range: $110,000- $140,000 (Based on experience)

About Us:

At Focus Health, we're reimagining primary care delivery in San Diego through an innovative, patient-centered approach that integrates specialized care directly into the primary care setting. As a growing foundation medical group, we're disrupting traditional healthcare models to create more accessible, comprehensive care for patients with serious illness.

Our embedded palliative care program represents a groundbreaking approach to supporting patients with serious illness, with a particular focus on dementia care and a plan to integrate other service lines in future phases. Our specialized care pod provides comprehensive support across the entire care continuum, primarily in our outpatient clinic setting while maintaining flexibility to support patients wherever they are in their journey. The pod model consists of a physician, nurse practitioner, social worker, RN, and MA.

Job Summary:

The Palliative Care Nurse serves as a clinical expert and care coordinator for patients with dementia or other serious illnesses requiring palliative care. This position plays a vital role in supporting comprehensive, patient-centered care across the continuum of care settings. Working within an interdisciplinary team that includes physicians, advanced practice providers, social workers, and chaplains, the nurse delivers expert palliative nursing care with a specialized focus on patients with serious illness. The role encompasses coordinating care transitions, managing symptoms, facilitating advance care planning, patient/family education, and serving as a resource to healthcare staff across multiple care settings.

Key Responsibilities:

Clinical Care

Assess, facilitate, and coordinate new and existing patient access to full-scope palliative care services using Epic workflows
Conduct comprehensive serious illness assessments, including physical symptoms, medication side effects, cognitive status, functional abilities, medication review, and psychosocial/cultural needs
Collaborate with the palliative care team to implement triage criteria that prioritizes urgent patient needs
Manage incoming referrals, determine eligibility, assess urgency, and input referrals into appropriate tracking systems
Maintain an organized patient panel with stratification by acuity level to ensure appropriate resource allocation and follow-up frequency
Prepare daily census accounting for patient changes and staffing needs
Coordinate care transitions between inpatient, outpatient, and community settings
Attend interdisciplinary rounds and contribute meaningfully to patient care discussions
Develop and implement care plans that support patients in acute, sub-acute, home, telehealth and community settings to prevent unnecessary hospital admissions, including early identification of symptom escalation and appropriate interventions
Identify families in crisis and follow established protocols to ensure their needs are addressed promptly

Clinical Care and Symptom Management

Provide expert nursing assessment and interventions for symptom management in patients with serious illnesses
Document all care accurately and timely in the electronic medical record according to departmental policies
Oversee the management of patients in lower acuity levels of need by performing needs assessments and applying program interventions
Apply non-pharmacologic management strategies for disease-related behaviors and provide caregiver education/support
Participate in advance care planning discussions with elderly patients and families
Complete documentation of advance directives and POLST forms
Implement evidence-based interventions for pain and symptom management specific to older adults
Communicate palliative care plans to referring providers and unit clinical teams to ensure recommendations are implemented
Monitor moderate to distressing symptoms and report to palliative care physicians/APPs
Facilitate family meetings to address goals of care and end-of-life planning
Maintain regular contact with patients and families via telephone and in-person visits to address evolving needs

Patient and Caregiver Support and Education

Serve as a resource to patient care units, outpatient clinics, and care staff regarding palliative care
Identify learning needs of patient care staff and communicate these to program leadership
Provide education to patients and families about palliative care options, advance care planning, and services available
Make referrals to appropriate community-based services based on comprehensive needs assessment
Develop and deliver educational presentations on palliative care topics to clinic staff
Identify and communicate opportunities for quality improvement to program leadership
Create and maintain educational resources for patients and families

Quality Improvement and Program Support

Contribute to maintaining and updating program tools (questionnaires, assessment instruments)
Create ad hoc reports for program leaders and team members as needed
Set appropriate priorities among competing demands
Identify barriers to optimal pain and symptom management in patients with serious illnesses
Collaborate with team members to develop and implement quality improvement initiatives
Utilize available information technology to support day-to-day work operations
Meet weekly with interdisciplinary team to review patient panel and summarize interventions
Follow clinic policies and documentation protocols (documentation and compliance)

Qualifications:

Education and Licensure

Bachelor's degree in Nursing required
Current Registered Nurse license in California
Preferred or willingness to obtain certification in palliative care, dementia or hospice and palliative nursing (CHPN, ACHPN, or GRN)
Minimum of 2-5 years clinical nursing experience
Experience in an academic medical center or large community hospital preferred
Demonstrated experience with patients with serious illnesses, patient assessments and symptom management
Experience facilitating advance care planning conversations
Experience with Epic electronic health record system preferred

Knowledge and Abilities

Expert knowledge of evidence-based palliative care practices
Strong understanding of pain and symptom management
Knowledge of age-related physiological changes and their impact on medication management
Excellent communication skills with ability to discuss sensitive end-of-life issues
Ability to communicate clearly, patiently, professionally, and compassionately via telephone and written communications
Strong organizational and critical thinking skills with ability to triage multiple competing priorities
Ability to work independently while collaborating effectively with interdisciplinary teams
Demonstrated skill in care coordination across multiple settings
Cultural competency in providing care to diverse patient populations
Proficiency with electronic health records, Microsoft Office Suite, and basic computer applications
Ability to maintain patient confidentiality and adhere to HIPAA regulations
Demonstrated skill in accurately assessing patient/family needs and identifying those requiring urgent intervention
Demonstrate a commitment to professional development by staying current with evidence-based palliative care practices emerging research, and clinical guidelines.
Actively seeks to integrate new knowledge into patient care workflows to ensure optimal outcomes and quality of life for patients and their families

Working Relationships:

Reports to: Medical Director of Palliative Care
Works collaboratively with: Palliative care physicians, APPs, social workers, chaplains, pharmacists, unit-based nursing staff, primary care teams, and care management staff

Physical Requirements:

Ability to perform standard physical demands of clinical nursing role
Capability to spend extended time sitting, standing, and walking between patient areas
Ability to communicate clearly in person and by telephone

What We Offer:

Comprehensive benefits package including healthcare, retirement plans, and paid time off

Join Our Quest: Ready to make a difference every day? We're calling on heroes like you to revolutionize patient care. Let's make healthcare history together!

Metis Practice Solutions is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, sex, sexual orientation, gender identity, age, marital status, status as a protected veteran, or status as a qualified individual with disability.

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