Director of Nursing (Hospice DPCS) - Orange, $140k to $160k

Job Description, Qualifications \& Performance Standards

**Department:** Clinical Operations
**Position:** Director of Patient Care Services (DPCS)
**Classification:** Exempt – Management
**Reports To:** Administrator / Governing Body
**Clinical Collaboration:** Medical Director
**Supervises:** Clinical Supervisors, RN Case Managers, LVNs/LPNs, Hospice Aides/CHHAs and other clinical personnel as assigned

I. POSITION SUMMARY

The Director of Patient Care Services (“DPCS”) is the Registered Nurse responsible for the overall direction, coordination, supervision, quality, and regulatory compliance of patient care services provided by Graceland Hospice Care.

The DPCS provides clinical leadership to ensure that hospice services are delivered safely, effectively, compassionately, timely, and in accordance with each patient’s individualized plan of care.

The DPCS is responsible for maintaining clinical operations consistent with applicable California hospice licensing requirements, Medicare Hospice Conditions of Participation, CMS requirements, applicable federal and state laws and regulations, Graceland Hospice Care policies and procedures, and applicable accreditation requirements, including Joint Commission standards when applicable.

The DPCS works collaboratively with the Administrator, Medical Director, interdisciplinary group (“IDG”), Quality/Compliance personnel, and clinical leadership to ensure that Graceland Hospice Care provides high\-quality end\-of\-life care focused on comfort, dignity, symptom management, patient rights, patient safety, and patient/family goals.

II. CALIFORNIA MINIMUM QUALIFICATIONS

The DPCS must meet all current California licensing requirements applicable to the position.

At minimum, the DPCS shall:

* Be a Registered Nurse with a current and valid California license.
* Meet one of the following qualification pathways:

Be a Registered Nurse with a minimum of four (10\) years of full\-time supervisory or managerial experience in a hospice or home health agency.

III. PREFERRED QUALIFICATIONS

In addition to the regulatory minimum qualifications,

· Bachelor of Science in Nursing (BSN) or higher degree.

· Three 10 years or more years of hospice clinical experience.

· Previous DPCS, Director of Nursing, Clinical Director, Clinical Supervisor, or comparable hospice leadership experience.

· Demonstrated knowledge of Medicare Hospice Conditions of Participation under 42 CFR Part 418\.

· Experience with California Department of Public Health hospice surveys.

· Joint Commission hospice accreditation and survey experience.

· Experience with CMS audits, ADRs, TPEs, medical\-record requests, and other payer audits.

· QAPI leadership experience.

· Hospice eligibility and documentation expertise.

· Experience managing a high\-volume hospice census.

· Experience supervising interdisciplinary clinical teams.

· Strong knowledge of hospice EMR systems (HospiceMD)

· Experience developing corrective action plans and Plans of Correction.

· Demonstrated ability to analyze clinical performance data and implement sustainable corrective actions.

IV. ESSENTIAL FUNCTIONS AND RESPONSIBILITIESA. CLINICAL OPERATIONS

The DPCS shall:

* Direct, coordinate, and supervise patient care services provided by Graceland Hospice Care.
* Ensure that hospice care is provided in accordance with accepted professional standards, applicable laws and regulations, the patient’s individualized plan of care, and Graceland Hospice Care policies.
* Maintain appropriate oversight of clinical operations throughout the hospice’s approved geographic service area.
* Ensure that patients receive appropriate, timely, safe, and effective hospice services.
* Ensure that clinical services focus on palliation, comfort, dignity, symptom management, and patient/family goals.
* Evaluate clinical staffing needs based upon census, patient acuity, geography, visit requirements, levels of care, and anticipated admissions.
* Ensure adequate clinical staffing is maintained.
* Ensure that staff assignments are appropriate to each clinician’s licensure, competency, experience, and scope of practice.
* Review clinical operations for delays, missed visits, incomplete services, inadequate follow\-up, or other patient\-care concerns.
* Intervene immediately when patient safety, quality of care, or regulatory compliance may be compromised.

VI. INTERDISCIPLINARY GROUP (IDG) OVERSIGHT

The DPCS shall provide clinical leadership and oversight of the interdisciplinary care process.

Responsibilities include:

* Ensuring the IDG appropriately coordinates, directs, and supervises hospice care.

ursing services are provided within applicable scope\-of\-practice requirements and under appropriate supervision.

The DPCS shall ensure LVNs/LPNs:

· Work within their lawful scope of practice;

· Follow the established plan of care;

· Receive appropriate RN supervision;

· Report changes in patient condition promptly;

· Document services accurately and timely; and

· Demonstrate competency for assigned duties.

X. HOSPICE AIDE / CHHA OVERSIGHT

The DPCS shall ensure appropriate RN supervision of hospice aides and CHHAs.

The clinical supervision system shall include:

· Appropriate aide care plans and assignments;

· Written patient\-care instructions;

· Required supervisory visits;

· Annual observation and competency requirements;

· Monitoring aide documentation;

· Monitoring infection\-control practices;

· Monitoring compliance with the plan of care;

· Evaluation of aide performance;

· Investigation of complaints involving aide services; and

· Remediation and competency reassessment when deficiencies are identified.

XI. ADMISSIONS AND START OF CARE

The DPCS shall maintain appropriate clinical oversight of the admission process.

Responsibilities include ensuring:

· Appropriate hospice referrals are clinically evaluated.

· Eligibility concerns are referred to the Medical Director.

· Admissions are completed timely.

· Initial assessments and comprehensive assessments meet regulatory requirements.

· Medications, supplies, equipment, and services necessary for immediate patient needs are arranged.

· Patient and family education is provided.

· Patients understand how to access hospice twenty\-four hours per day.

· Appropriate documentation is completed.

· The IDG receives necessary admission information.

XII. PAIN AND SYMPTOM MANAGEMENT

The DPCS shall promote aggressive, clinically appropriate palliative symptom management consistent with patient goals and physician orders.

Clinical oversight shall include:

· Pain;

· Dyspnea;

· Anxiety;

· Agitation;

· Nausea and vomiting;

· Constipation;

· Secretions;

· Wounds;

· Nutrition/hydration concerns;

· Medication side effects;

· Terminal restlessness;

· Psychosocial distress; and

· Symptoms associated with active dying.

The DPCS shall promote timely physician notification and intervention when symptoms are uncontrolled.

XIII. MEDICATION MANAGEMENT

The DPCS shall participate in systems designed to promote safe medication management.

Responsibilities include:

· Medication reconciliation;

· Monitoring medication profiles;

· Identifying duplications, interactions, contraindications, or discrepancies;

· Ensuring medication orders are appropriately obtained and documented;

· Monitoring high\-risk medications;

· Reviewing medication errors;

· Monitoring controlled\-substance concerns;

· Ensuring appropriate medication disposal education;

· Coordinating with pharmacy providers; and

· Monitoring timely medication availability.

XIV. QAPI – QUALITY ASSESSMENT AND PERFORMANCE IMPROVEMENT

The DPCS shall actively participate in and provide clinical leadership to Graceland Hospice Care’s QAPI program.

Responsibilities include:

* Reviewing patient\-care quality indicators.
* Identifying high\-risk, high\-volume, and problem\-prone clinical processes.
* Monitoring adverse patient events.
* Identifying trends and systemic clinical risks.
* Participating in Performance Improvement Projects.
* Developing measurable corrective actions.
* Evaluating whether corrective actions are effective.
* Reporting clinical quality findings to the Administrator, QAPI Committee, Medical Director, and Governing Body as appropriate.
* Monitoring clinical outcomes.
* Maintaining documentary evidence demonstrating quality\-improvement activities.

Potential QAPI indicators include:

· Pain control;

· Falls;

· Medication errors;

· Hospitalizations;

· Emergency department utilization;

· Revocations;

· Live discharges;

· Complaints;

· Missed visits;

· On\-call response;

· Infection\-control events;

· Wounds;

· Documentation deficiencies;

· Hospice aide supervision;

· Patient/family satisfaction;

· Untimely admissions;

· Service failures; and

· Other identified clinical risks.

XV. ADR, TPE AND MEDICARE AUDIT RESPONSIBILITIES

The DPCS shall participate in clinical preparation and response to:

· Additional Documentation Requests (ADRs);

· Targeted Probe and Educate (TPE) reviews;

· Medicare Administrative Contractor reviews;

· UPIC or other program\-integrity reviews;

· RAC reviews when applicable;

· Medical\-record audits;

· Payment reviews;

· CDPH investigations;

· Accreditation reviews; and

· Other governmental or payer requests.

Responsibilities may include:

* Reviewing requested medical records for completeness.
* Evaluating whether documentation demonstrates terminal prognosis.
* Reviewing certifications and recertifications.
* Reviewing physician narratives.
* Reviewing face\-to\-face documentation when applicable.
* Reviewing IDG documentation.
* Reviewing nursing and interdisciplinary documentation for evidence of decline.
* Identifying clinical documentation deficiencies.
* Coordinating corrective education.
* Participating in root\-cause analysis following denials.
* Developing corrective action plans.
* Monitoring corrective action effectiveness.

The DPCS shall promptly escalate suspected fraud, falsification, improper billing, or other compliance concerns in accordance with Graceland Hospice Care’s compliance policies.

XVI. CDPH REGULATORY COMPLIANCE

The DPCS shall assist Graceland Hospice Care in maintaining continuous compliance with California hospice licensing requirements.

Responsibilities include:

· Maintaining awareness of applicable California hospice regulations.

· Cooperating with CDPH surveys and investigations.

· Maintaining survey readiness.

· Providing requested clinical records.

· Participating in staff interviews and survey activities.

· Responding to identified deficiencies.

· Assisting in development and implementation of Plans of Correction.

· Monitoring corrective actions.

· Ensuring sustained compliance following surveys.

· Immediately informing the Administrator of significant regulatory concerns.

XVII. CMS CONDITIONS OF PARTICIPATION

The DPCS shall maintain working knowledge of applicable Medicare Hospice Conditions of Participation under 42 CFR Part 418\.

The DPCS’s clinical responsibilities include oversight or participation relating to:

· Patient rights;

· Initial and comprehensive assessments;

· Interdisciplinary group requirements;

· Plans of care;

· Coordination of services;

· QAPI;

· Infection control;

· Hospice aide services;

· Nursing services;

· Clinical records;

· Organization and administration;

· 24/7 availability;

· Staff competency;

· Medication management;

· Levels of care;

· Certification/recertification requirements; and

· Other applicable Medicare hospice requirements.

XVIII. JOINT COMMISSION RESPONSIBILITIES

When Graceland Hospice Care maintains or seeks Joint Commission accreditation, the DPCS shall serve as a key clinical leader for continuous accreditation readiness.

Responsibilities include:

· Maintaining ongoing survey readiness rather than preparing only immediately before survey.

· Participating in tracer activities.

· Reviewing patient records for accreditation compliance.

· Participating in mock surveys.

· Correcting identified clinical deficiencies.

· Monitoring patient\-safety practices.

· Monitoring medication\-management practices.

· Ensuring staff competency documentation.

· Monitoring infection\-prevention practices.

· Participating in performance\-improvement activities.

· Participating in leadership and patient\-safety meetings.

· Preparing staff for survey interviews.

· Participating in corrective action following survey findings.

· Maintaining evidence demonstrating sustained compliance.

· Monitoring current Joint Commission Home Care requirements applicable to hospice operations.

XIX. INFECTION PREVENTION AND CONTROL

The DPCS shall support and enforce Graceland Hospice Care’s infection prevention and control program.

Responsibilities include:

· Standard precautions;

· Hand hygiene;

· PPE;

· Exposure prevention;

· Sharps safety;

· Bloodborne pathogen requirements;

· Communicable\-disease precautions;

· Employee education;

· Patient/family education;

· Infection surveillance;

· Reporting requirements;

· Investigation of infection trends; and

· Corrective action.

XX. INCIDENT, COMPLAINT AND RISK MANAGEMENT

The DPCS shall ensure timely clinical investigation and follow\-up regarding:

· Patient/family complaints;

· Falls;

· Medication errors;

· Missed visits;

· Delayed care;

· Uncontrolled symptoms;

· Hospitalizations;

· Emergency department visits;

· Abuse or neglect allegations;

· Patient injuries;

· Staff misconduct;

· Documentation irregularities;

· Patient abandonment concerns;

· Infection\-control events;

· Equipment failures; and

· Other significant clinical events.

The DPCS shall immediately escalate serious patient\-safety, abuse/neglect, regulatory, fraud, or compliance concerns to appropriate leadership.

XXI. STAFF SUPERVISION AND LEADERSHIP

The DPCS shall provide professional leadership to clinical personnel.

Responsibilities include:

· Recruitment and interviewing;

· Orientation;

· Training;

· Clinical supervision;

· Coaching;

· Performance evaluations;

· Competency evaluations;

· Corrective counseling;

· Performance improvement plans;

· Disciplinary recommendations;

· Scheduling oversight;

· Workload management;

· Staff education;

· Conflict resolution; and

· Staff accountability.

The DPCS shall promote a professional clinical culture based upon patient safety, teamwork, accountability, compassion, communication, ethical conduct, regulatory compliance, and respect.

XXII. STAFF COMPETENCY

The DPCS shall ensure that clinical personnel demonstrate competency appropriate to their assigned responsibilities.

Competency oversight may include:

· Hospice philosophy;

· Pain and symptom management;

· Medication management;

· Emergency procedures;

· Infection control;

· Patient rights;

· Abuse/neglect reporting;

· Documentation;

· Hospice eligibility;

· End\-of\-life care;

· Death and dying;

· Cultural sensitivity;

· Communication;

· Plan\-of\-care implementation;

· Hospice aide supervision;

· Equipment safety;

· Emergency preparedness; and

· Scope\-of\-practice requirements.

Deficiencies in competency shall result in appropriate education, supervision, remediation, reassessment, or corrective action.

XXIII. EMERGENCY PREPAREDNESS

The DPCS shall participate in Graceland Hospice Care’s emergency preparedness program.

Responsibilities include:

· Identification of high\-risk patients;

· Clinical emergency planning;

· Continuity\-of\-care planning;

· Emergency staffing;

· Communication procedures;

· Disaster preparedness;

· Medication, oxygen, DME, and supply contingency planning;

· Participation in emergency drills;

· After\-action evaluation; and

· Corrective action.

XXIV. MANAGEMENT COMMUNICATION

The DPCS shall maintain effective communication with:

· Governing Body;

· Administrator;

· Medical Director;

· Clinical Supervisors;

· Compliance/Quality personnel;

· Human Resources;

· RN Case Managers;

· LVNs;

· Hospice Aides/CHHAs;

· Social Workers;

· Chaplains;

· Bereavement personnel;

· Pharmacy;

· DME providers;

· Contracted providers;

· Physicians;

· Facilities; and

· Other members of the interdisciplinary team.

Serious clinical, regulatory, staffing, compliance, or patient\-safety issues shall be communicated promptly to appropriate leadership.

XXV. PROFESSIONAL AND ETHICAL EXPECTATIONS

The DPCS shall:

· Demonstrate integrity and professional judgment.

· Maintain patient confidentiality.

· Protect HIPAA\-protected information.

· Maintain appropriate professional boundaries.

· Avoid conflicts of interest.

· Promote truthful and accurate clinical documentation.

· Cooperate with legitimate audits and investigations.

· Report suspected fraud, abuse, neglect, falsification, or regulatory violations.

· Maintain professional conduct with patients, families, employees, physicians, vendors, regulators, and community partners.

· Demonstrate respect for patient autonomy, dignity, culture, beliefs, and end\-of\-life preferences.

Job Type: Full\-time

Pay: $140,000\.00 \- $150,000\.00 per year

Benefits:

* 401(k)
* 401(k) matching
* Dental insurance
* Employee assistance program
* Flexible spending account
* Health insurance
* Life insurance
* Paid time off
* Vision insurance

Work Location: In person