Transitional Care Nurse LPN / RN

JOB SUMMARY

 

• Responsible for overseeing the coordination of care, day to day operations of the post- acute programs and services to all transitional care patients. This includes assessing the effectiveness and the needs of the programs, development, and planning of services, organizing, and coordinating the implementation of services, monitoring, and evaluating the effectiveness and efficiency of the programs and services. The Transitional Care Nurse is accountable for maintaining compliance with current federal, state, and local standards, guidelines and regulations, facility policies, and as directed by Alden Management Services.

 

QUALIFICATIONS

 

• Demonstrated success in external marketing to physicians, discharge planners and other healthcare referral sources preferred.
• Prefer a graduate of a four-year college with one year’s experience in the health care or long-term care field or have an equivalent combination of education and experience.
• Requires excellent communication skills, verbal and written.
• Must possess a current, unencumbered license to practice as an RN or an LPN in the state(s) where facility(s) are located.
• Must be knowledgeable of short-term practices and procedures, as well as some familiarity with laws, regulations and guidelines pertaining to Long Term care.
• Must possess current CPR certificate or become certified within 90 days of employment.
• Must be knowledgeable of nursing and medical practices and procedures.
• Must possess the ability to make independent decisions when circumstances warrant such action.
• Leads and supervises to create a positive working atmosphere.
• Committed to improving the quality of life for those we serve and possess the ability to work in a team environment that is resident centered.
• Must have strong interpersonal skills and advanced customer service skills.
• Must possess the ability to deal tactfully with patients, family members, hospital and facility personnel, visitors, government agencies/personnel, and the general public.
• Must possess leadership and supervisory ability and willingness to work harmoniously with other personnel.

 

PHYSICAL REQUIREMENTS

 

• Must be able to move intermittently throughout the workday.
• Must be able to cope with the mental and emotional stress of the position.
• Must possess sight/ hearing senses or use prosthetics that will enable these senses to function adequately so that the requirements of this position can be fully met.
• Must be in good general health and demonstrate emotional stability.
• Must be able to relate well and work with the ill, disabled, elderly, emotionally upset and at times hostile people within the facility.
• Prolonged standing/walking is required.
• May be required to lift, push, pull, and move equipment, supplies, etc., throughout the day.
• Is subject to exposure to infectious waste, diseases, conditions, etc., including exposure to the (HIV) AIDS and Hepatitis B viruses.

 

ESSENTIAL FUNCTIONS

 

• Work collaboratively with internal staff to share our message of quality care and service.
• Understand and be able to communicate the Post-Acute Programs.
• Collaborate with Facility Administration in the planning, coordination, and implementation of a marketing plan.
• Networking and communicating with physicians, hospital, case managers, home health care agencies and other healthcare referral sources to present facility and Alden information.
• Gather patient referrals and evaluate potential patient admissions that contribute to Alden’s overall revenue growth.
• Attend and participate in facility marketing meetings.
• Review admission referrals in preparation for receiving the admission and ensuring that the patient is appropriate for the program and that all programs and services will be promptly implemented upon admission and collaborates with hospital nursing staff as needed.
• Evaluate and assess patients in the hospital setting prior to admission to the facility, when applicable to ensure for smooth hand off from one healthcare setting to another.
• Educate the patients, families, or responsible parties about the transition process into the facility and remain engaged through the admission process and through discharge to the next level of care.
• Completes customer care phone calls post transition from facility.
• Review admission data for tracking and trending post-acute programs and their referral sources.
• Streamline the admission process by acquiring needed information before the referral is sent to the facility.
• Learn with the hospital process for referrals and assist to ensure a smooth transition to the facility.
• Collaborate with facility staff to review patient care goals and strategies for discharge planning.
• Accept and support the Alden Mission, Our Promise, Customer Service Values and Motto.
• Accepts and supports the Administrator and Transitional Care Support Team philosophy of care.
• Assess, Plan, develop, organize, implement, evaluate, and direct the facility in its post-acute and transitional care programs and services to ensure quality of care is being rendered.
• Sure, that all procedures are followed in accordance with established post-acute and transitional care processes and policies.
• Directly collaborates with employees and instruct staff providing education and training to promote job knowledge related to post-acute programs and services.
• Identify problems, develop, and implement solutions with the assistance of the Administrator and the Alden Post-Acute Support Team.
• Collaborate with Administrative team with concerns or complaints from patients, families, staff, outside resources.
• Performs other duties as assigned.

 

GENERAL BENEFITS:

• Paid Holidays

• Paid Sick Time

• Paid Time Off

• Retirement / Pension Plan

• Health Insurance

• Dental Insurance

• Life Insurance

• Vision Insurance