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Nursing Case Management Specialist
2 months ago
As a vital member of the healthcare team, the Clinical Transition Specialist RN is responsible for overseeing and managing the functional and financial outcomes for patients experiencing acute illnesses that necessitate hospitalization. This role is crucial in ensuring that patients receive comprehensive assessments, continuous evaluations, and effective discharge planning, facilitating a seamless transition from the hospital to the appropriate level of care.
Key Responsibilities:
1. **Patient Assessment and Planning:**
- Conduct thorough initial assessments to identify patient needs.
- Develop and implement individualized discharge plans in collaboration with the healthcare team.
2. **Coordination of Care:**
- Act as a liaison between patients, families, and healthcare providers to ensure continuity of care.
- Facilitate multidisciplinary rounds to promote timely planning and collaboration among care team members.
3. **Monitoring and Evaluation:**
- Regularly evaluate the effectiveness of care plans and make necessary adjustments to meet patient goals.
- Document all aspects of care and utilization in the appropriate systems.
4. **Education and Support:**
- Provide education to patients and families regarding post-hospital care and resources available.
- Conduct case review presentations to share insights and improve practices among peers.
Qualifications:
- **Education:** Associate's Degree in Nursing required; Bachelor's Degree in Nursing must be obtained within five years of hire.
- **Licensure:** Must possess a valid Registered Professional Nurse (RN) License in Illinois and obtain Accredited Case Manager Certification within three years.
- **Experience:** Minimum of three years in a related field is required.
Skills and Competencies:
- Strong communication and organizational skills.
- Ability to work independently and collaboratively within a multidisciplinary team.
- Proficient in managing multiple patient cases concurrently with attention to detail.
Additional Information:
Successful candidates will demonstrate a commitment to ongoing education and professional development, particularly in the care of acute stroke patients. The role requires a proactive approach to patient care, ensuring that all necessary follow-up appointments and services are arranged prior to discharge. This position plays a critical role in enhancing patient outcomes and reducing readmission rates, contributing to the overall mission of the Carle Foundation Hospital.
