Care Coordination Registered Nurse

2 weeks ago

Kissimmee, Florida, United States AdventHealth Full time

Comprehensive Benefits and Advantages for You and Your Family:

  • Immediate Access to Benefits
  • Paid Time Off from the Start
  • Tuition-Free Education (Certifications and Degrees without personal tuition costs)

Our Commitment to You:

Becoming a part of AdventHealth means joining a larger mission. It’s about being part of a community that values the holistic well-being of every individual and strives to uplift others in body, mind, and spirit. At AdventHealth, you will have the opportunity to excel in your career while also nurturing your spiritual growth, all while contributing to the Healing Ministry of Christ. You will be appreciated for your individuality and the unique experiences you bring to our purpose-driven team, understanding that together we achieve more.

Work Schedule: Full-Time

Shift: Daytime

Community Overview:

  • AdventHealth Kissimmee is a 242-bed hospital focused on community health
  • Strategically located near major attractions
  • The dedicated team is committed to providing mission-driven, faith-based care to the residents and visitors of the surrounding areas
  • Recently expanded facilities include additional beds and new ancillary services such as Rehabilitation, Dialysis, Laboratory, and Imaging.

Your Role:

The RN Care Manager collaborates with patients, families, social workers, nursing staff, physicians, and the interdisciplinary team to ensure coordinated, patient-centered care throughout the healthcare continuum. This role is essential in promoting efficient and cost-effective care by monitoring resources and escalating clinical care as necessary. Under the guidance of the Care Management Supervisor or Manager, the RN Care Manager evaluates patient needs post-hospitalization, develops transition of care plans, and initiates these plans prior to patient discharge. Responsibilities also include optimizing patient flow, enhancing continuity of care, ensuring patient satisfaction, and preventing readmissions.

Value Added to the Team:

  • Conducts initial evaluations for transition of care needs for all identified patients promptly and documents findings according to established policies.
  • Incorporates patient and family goals into care planning and communicates these to the multidisciplinary team.
  • Identifies and collaborates with the healthcare team to address barriers to achieving care plans.
  • Facilitates discussions regarding end-of-life care, advance directives, and community resources.
  • Actively participates in daily multidisciplinary rounds to review patient care progression and discharge plans.
  • Ensures compliance with patient notifications and documentation in a timely manner.

Professional Development:

Encourages personal growth and development by meeting educational requirements and supporting departmental goals that contribute to the overall success of the organization.

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