Care Transitions Nurse: Discharge & Care Coordination

Holy Name Medical Center; Teaneck Township (NJ); On-site; USD 94,000 - 109,000; Full time

Benefits offered by this job

401(k) matching

Tuition reimbursement

Paid time off

Flexible spending accounts

Life insurance

Free on-site parking

Job summary

Holy Name Medical Center in Teaneck, NJ is seeking a RN Care Transitions Coordinator to lead discharge planning and post-acute care coordination. The role focuses on safe, cost-effective care and reduced length of stay through interdisciplinary collaboration.

Responsibilities include plan modifications, communications with payors, and arranging home care referrals, transportation, and post-discharge support while ensuring regulatory compliance.

Qualifications

• 4-6 years of acute care experience required
• Disease management and discharge planning experience preferred
• Analytical and problem-solving abilities with strong verbal and written communication skills

Responsibilities

• Modification of plan of care to meet ongoing patient needs
• Communicate information to third party payors and care team
• Complete required documentation in patient records
• Issues Notices of Non-Coverage per hospital policy
• Refer appropriate cases for social work intervention
• Knowlegeable about Indigent Medication Programs
• Verify patient demographics and insurance information
• Expedites execution of plan of care for patients in Observation units
• Arrange transportation for discharged patients
• Ensure compliance with regulatory standards for Observation patients (CMS Code 44)
• Use Patient Choice list for post-discharge support and document
• Initiate home care referrals and arrange ambulance transportation as needed
• Participate in discharge rounds and advocate for patient in discharge planning
• Attend family meetings as indicated
• Other duties as assigned

Skills

Analytical thinking

Communication skills

Education

Bachelor's Degree BSN Preferred

Job description

Holy Name Medical Center in Teaneck, NJ is seeking a RN Care Transitions Coordinator to lead discharge planning and post-acute care coordination. The role focuses on safe, cost-effective care and reduced length of stay through interdisciplinary collaboration.

Responsibilities include plan modifications, communications with payors, and arranging home care referrals, transportation, and post-discharge support while ensuring regulatory compliance.