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Clinical Transition Specialist RN
2 months ago
- Act as a liaison working with patient/family and physician to determine next level of care
- Conducts case review presentations to educate peers on unique or challenging cases and scope of practice issues.
- Coordinates the transition from inpatient care to post-hospital care, working with pre- and post- hospital providers to ensure responsive and appropriate care is provided post-discharge.
- Documents plan of care and utilization issues in appropriate locations, including but not limited to: case management/utilization review software and the multidisciplinary plan of care document on all assigned patients.
- Evaluates effectiveness of plan of care to ensure the progression toward desired patient outcomes.
- Initiates intervention, both pre-hospital, in-hospital, and post-hospital, for patients and families identified from a proactive initial admission assessment, as well as through referrals from members of the health care team.
- Initiates timely referrals to other health care team members (quality improvement, risk manager, social workers, physicians, Home Services, etc.)
- Performs nursing activities of assessment, coordination, planning, monitoring, implementation, and evaluation. Interacts with clients, caregivers and families to assess, plan care, arrange services, monitor, and provide support and education.
- Proactively investigates coverage for post-hospital needs and presents options to the patient/family and provider.
- Provides oversight of acute setting plan of care to ensure coordination and completion of services to meet post-hospitalization needs.
- Lead an interdisciplinary team to achieve organizational goals related to length of stay and readmissions.
- Track avoidable days on inpatient stays.
- Readmission assessment of inpatient stays.
- Assess patients for post discharge needs.
- Participate in daily white board rounds.
- Arrange DME, Home Care, Hospice, assisting with returns to ECFs, and Transportation
- Assist any patient/family care conferences.
- Participate in department work groups.
- HRHC: make follow up appointments with primary care provider before patient discharges, makes post discharge phone calls to ensure patient is doing well and has what they need for success. Obtain prior authorizations for swing bed patients, maintain the work ques, and address denials.
- RMH: make follow up appointments with primary care provider before patient discharges, makes post discharge phone calls to ensure patient is doing well and has what they need for success. Initial utilization review for emergency room patients being admitted.
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Clinical Transition Specialist RN
2 months ago
Muncie, United States CARLE Full timeResponsible for the oversight, coordination, and management of the functional and financial outcomes during acute illness requiring hospitalization for patients of the Carle Foundation Hospital. Ensures patients receive proactive initial assessment of needs, ongoing evaluations, and initiation of discharge planning while facilitating a safe and timely...
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Clinical Nurse Specialist
7 days ago
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Clinical Nurse Specialist
7 days ago
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Nurse Specialist
2 days ago
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Traveling Respiratory Care Specialist
1 week ago
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Clinical Nurse
3 days ago
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Client Success Specialist
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Inclusive Education Specialist
1 week ago
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Rehabilitation Specialist
1 week ago
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Staffing Specialist
7 days ago
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Staffing Specialist
7 days ago
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Sleep Study Specialist
1 week ago
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Registered Nurse
1 week ago
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RN - Urology (Clinic)
1 month ago
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Weekend Nurse Supervisor
3 months ago
Muncie, United States Brickyard Healthcare Full timeBrickyard Healthcare - We rely on and trust our Nurse Supervisor (RN) to provide independent supervision of the delivery of care to a group of residents in a nursing unit. Assess resident needs, develop individual care plans, administer nursing care, and evaluate nursing care. Supervise Licensed Practical Nurses, Care Specialists (CNA) and other...
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Weekend Nurse Supervisor
2 months ago
Muncie, United States Brickyard Healthcare Full timeWe rely on and trust our Nurse Supervisor (RN) to provide independent supervision of the delivery of care to a group of residents in a nursing unit. Assess resident needs, develop individual care plans, administer nursing care, and evaluate nursing care. Supervise Licensed Practical Nurses, Care Specialists (CNA) and other personnel. May supervise...
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Manager of Clinical Operations
1 week ago
Muncie, Indiana, United States Indiana University Health Full timeJoin IU Health: A Leader in Healthcare Become part of one of the largest nonprofit health systems in the United States, IU Health, which encompasses a network of 16 hospitals serving diverse communities. With a commitment to delivering exceptional healthcare services, IU Health is recognized nationally for its excellence in patient care across various...
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Experienced Orthopedic Specialist
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Clinical Medical Physicist
7 days ago
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Clinical Medical Physicist
7 days ago
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