Care Transitions Nurse

Svdpnky; Dallas (TX); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Affordable medical

Dental and vision benefits

Paid time off (PTO)

401K after 1 year

Job summary

Presbyterian Village North in Dallas is hiring a Full-Time Care Transitions Nurse (RN) to join the Skilled Nursing Department. This role includes managing admissions, coordinating with physicians, and leading care transitions with an emphasis on timely, patient-centered service.

You will participate in on-call rotations every fifth week, with additional on-call compensation. The position offers a supportive team environment, benefits, and opportunities for growth within Forefront Living's

Qualifications

• Current Registered Nursing license in good standing.
• Two years of admissions experience in a Long Term Care setting preferred.

Responsibilities

• Maintain admissions and readmissions of residents including physician orders and admission assessments.
• Provide clinical review and response of all hospital referrals within 30 minutes or less.
• Prioritize incoming referrals for timely response and discharge planning.
• Review MAR/TAR and communicate cost outliers and special needs with nursing before admission.
• Communicate clinical needs to the nursing team to prepare for resident admission.
• Complete preadmission screening in EHR and outline patient care.
• Initiate Interim Care Plan in EHR and meet new residents after admission.
• Coordinate with attending physician/NP on needs for new admissions.
• Assist with admission and discharge planning, as instructed by leadership.
• Coordinate Post Discharge calls and track rehospitalizations in EHR.

Skills

RN licensure

Admissions experience

Job description

Presbyterian Village North is immediately hiring for a Full-Time Care Transitions Nurse (RN) in our Skilled Nursing Department.

Shift:

Plus on-call rotation every 5th week, (Monday thru Sunday - all shifts) $250.00 on-call payment

Wonderful environment and strong teammate relationships! Affordable medical, dental, vision benefits and paid time off. 401K is available after your 1st year. Come grow with us!

With a shared legacy in business and healthcare innovation, Forefront Living's family of care-oriented organizations blends values built on compassion and faith with high-quality senior care - long-term care, Alzheimer’s and memory care, skilled nursing and rehabilitation therapies, hospice and palliative care.

These senior care services, along with the celebration of independent living at our senior lifestyle communities, combine to bring deeper meaning to every phase of life for people of all faiths, regardless of race, gender, color, religion, national origin or disability. Forefront Living is the not-for-profit, faith-based parent of Presbyterian Village North, The Outlook at Windhaven, Bella Vida, St. Joseph Village, and the T. Boone Pickens Hospice and Palliative Care Center.

ESSENTIAL DUTIES:

• Maintain admissions and re-admissions of residents including physician orders and admission assessments.
• Provides clinical review and response of all hospital referrals as provided by the Admission Coordinator and Clinical Liaison in 30 minutes or less
• Prioritizes incoming referrals on all clinical reviews for timely and quick response to the Admissions Coordinator and Clinical Liaison based on discharge plan
• Reviews MAR/TAR and communicates cost outliers and special needs with nursing before approving admission
• Communicates known clinical needs, based on a review of clinical records, to the nursing team to prepare for resident admission
• Completes Preadmission Screening in EHR outlining patient care on approved admissions before the admission
• Initiates Interim Care Plan in EHR
• Meets with new residents after admission to determine needs are met
• Communicates with the attending physician and/or NP on specified needs for new admissions
• Assist with admission, when necessary, as instructed by the Healthcare Administrator or Director of Nursing
• Assists with the Discharge Planning Process
• Coordinates and makes Post Discharge calls
• Tracks Rehospitalizations in the EHR
• Maintains current knowledge of the community's clinical capabilities and staffing levels
• Adheres to professional code of ethics.
• Performs other tasks as assigned by the Director of Nursing
• Staffing On-Call Rotation (every 5th week - Mon.-Sun., all shifts) + on-call pay

MINIMUM QUALIFICATIONS:

• Current Registered Nursing license in good standing
• Two years of admissions experience in a Long Term Care setting preferred