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Transitions of Care Registered Nurse
2 months ago
Transitions of Care Registered Nurse ($3,500 sign-on bonus)
- Evening and weekend shifts are mandatory
- Must possess a Compact RN License
- The Transitions of Care Registered Nurse at CareBridge plays a vital role within the clinical team, tasked with delivering patient outreach, triage, and disease education via telehealth methods to individuals receiving Home and Community-Based Services (HCBS) through state Medicaid programs, particularly those who have recently undergone an acute transition of care. This role requires close collaboration with families, natural supports, paid caregivers, specialty providers, and primary care physicians to ensure patients receive the essential care needed to remain in their homes.
Key Responsibilities:
- Deliver compassionate care to a diverse patient population and their families.
- Educate and triage individuals facing acute transitions of care with various health concerns, ranging from primary to urgent care.
- Collaborate effectively as part of an interdisciplinary team to facilitate a seamless continuum of care.
- Promote cost-effective, high-quality care for patients.
- Conduct follow-ups and check-ins with patients to monitor their post-discharge progress.
- Communicate with hospital, skilled nursing, and other acute care staff as necessary to oversee acute admission processes and finalize discharge planning.
- Actively engage in quality improvement initiatives and customer service programs.
- Review and reconcile patient medications.
- Escalate complex cases to advanced practice providers or clinical pharmacists as needed to achieve optimal patient outcomes.
- Recognize and respond promptly to emergency situations.
- Provide effective patient education utilizing the Teach-Back method.
- Document all patient interactions in accordance with established documentation standards.
- Participate in clinical case discussions.
- Organize and manage multiple tasks throughout the day efficiently.
- Maintain excellent punctuality and attendance during scheduled hours.
- This position will also provide cross-coverage on the inbound acute nurse line.
- Additional duties as assigned.
Qualifications:
- Must hold an active, unencumbered Compact RN license.
- Experience in caring for adult patients with chronic illnesses, chronically ill pediatric patients, and individuals with intellectual and developmental disabilities (IDD) is preferred.
- Experience in Utilization Management or Case Management is strongly preferred.
- Previous experience in Transitions of Care is a plus.
- Proficient in computer use and capable of effective documentation in electronic systems.
- Excellent communication skills over the phone, providing timely and appropriate guidance on healthcare issues.
- This role will consist of four (10-hour) shifts.
- Required days include Thursday - Sunday, or Saturday - Tuesday.
- An entrepreneurial mindset and a self-starter attitude.
- Flexibility and adaptability to a dynamic workload.
- Enjoyment of a fast-paced work environment.
- A sense of humor and a grounded nature.
Employment Type:
Full-Time
Location:
Remote
About CareBridge
CareBridge is a provider of technology and services that assist payers and states in managing care for patients receiving long-term support services.
