Transitional Care Specialist - RN
$90,000–$98,000 year
On-siteWoods Cross, Utah, United States
Job Summary
Facilitate seamless transitions of care for patients, families, and clinicians by assessing hospice eligibility, converting referrals to admission status, and coordinating with home health, hospice, and other continuum services. Build relationships with local hospitals, provider groups, and community members to educate on the RMC continuum and grow hospice census. Communicate daily with external and internal teams regarding referral status, patient assessments, and any obstacles to transitions. Perform daily census tracking for the facility and RMC transitions using electronic medical records and spreadsheets. Travel throughout RMC areas to support multiple teams and ensure continuity of care. On-call 24 hours per day, 7 days per week.
Required Qualifications
- Active Registered Nurse or Licensed Practical Nurse license in the state of Utah or a valid compact state license required.
- Minimum of 3-5 years of Hospice experience with demonstrated success of case management in home health and hospice, or transitional care.
- Knowledge and experience in working with multiple post-acute continuum of care services.
- Demonstrates strong communication and relationship skills with the ability to market and grow a Hospice census as well as RMC continuum care transitions.
- Ability to read, write, speak and understand the English language.
- Must be a supportive team member, contribute to and be an example of team work.
- Ability to make independent decisions when circumstances warrant such action.
- Ability to deal tactfully with personnel, residents, family members, visitors, government agencies/personnel and the general public.
- Must have patience, tact, and willingness to deal with difficult residents, family and staff.
- Must be able to relay information concerning a resident's condition.
- Must not pose a threat to the health and safety of other individuals in the workplace.
- Must be able to move intermittently throughout the workday.
- Meets general health requirements according to facility policy, including medical and physical exams and checking immunity status to various infectious diseases.
- Ability to work beyond normal working hours and on weekends and holidays when necessary.
- Ability to assist in evacuation of residents during emergency situations.
- Ability to bend, stoop, kneel, crouch, perform overhead lifting and perform other common physical movements as needed for the position.
- On call 24 hours per day, 7 days per week.
- Willing to work to task completion in spite of frequent interruptions.
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