Healthcare Transition Nurse, RN
3 weeks ago
We are seeking a skilled Healthcare Transition Nurse to join our team at Hill Physicians Medical Group. As a key member of our healthcare team, you will be responsible for facilitating smooth transitions through varying levels of care and throughout the care continuum.
Job SummaryThe Healthcare Transition Nurse will work closely with an interdisciplinary team to ensure effective resource utilization, quality, and cost-effective outcomes. You will monitor inpatient utilization, facilitate discharge planning, and provide discharge follow-up to ensure that medical care is appropriate and efficient.
Key Responsibilities- Support the interdisciplinary team approach to ensure effective resource utilization, quality, and cost-effective outcomes.
- Follow designated TOC workflows to assure consistency and accountability.
- Monitor inpatient utilization according to identified criteria.
- Facilitate discharge planning.
- Proactively and collaboratively interface with physicians, hospital staff, members, and their families to assist in expediting appropriate discharge.
- Serve as a liaison between the hospital, health plan, vendors, and providers.
- Coordinate internal and external resources for the individual member.
- May provide telephonic post-hospital follow-up to assure members' understanding of the discharge instructions and current treatment plan.
- Determine what home services were ordered at the time of discharge and assure that services ordered have been received or activated.
- Provide medication reconciliation and refer to pharmacist as warranted.
- Assure member is established with appropriate providers and is receiving appropriate and timely follow-up.
- Assess for any issues that may require ongoing case management.
- Assure member has adequate support.
- Support a positive work environment and foster teamwork.
- Maintain client privacy, safety, confidentiality, and advocacy while adhering to ethical, legal, regulatory, and accreditation standards.
To be successful in this role, you will need:
- A minimum three years of clinical nursing experience in an area such as medical surgical, critical care, home health, or skilled nursing with two years of managed-care experience preferred.
- Possess optimum organizational skills with the ability to meet both expected and unexpected time frames.
- Proficient in MS office applications and other computer skills.
- Ability to coordinate effectively with a variety of customers including members, providers, office staff, health plans, internal department, community resources, and peers.
- An active, unrestricted California Registered Nursing License.
Hill Physicians Medical Group offers a competitive salary of $84,900 to $118,000 per year, commensurate with experience.
This is a full-time position with opportunities for growth and development in a dynamic and supportive work environment.
We value diversity, equity, and inclusion and strive to create a workplace where everyone feels welcome and valued.
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