Hospice Transition Nurse: Care Bridge & Case Manager

St. Croix Hospice; Oak Creek (WI); On-site; USD 75,000 - 95,000; Full time

Job summary

St. Croix Hospice is seeking an experienced Hospice Transition Nurse to support patients, families, and hospital partners. The role focuses on education, referrals, and coordinating transition from hospital to home hospice care.

You will manage goals of care meetings, collaborate with hospitals and nursing homes, and mentor other RNs while traveling to patient locations across Wisconsin.

Qualifications

• Active RN license in state(s) of practice.
• 1+ years hospice/home care experience.
• Multistate licensure considerations as described in policy.
• Graduate of a professional nursing program and licensed.
• Ability to pass DHS background, consumer report, and drug test.
• Valid driver's license and access to reliable vehicle.

Responsibilities

• Acts as case manager for hospital patients and manages GIP patients when appropriate.
• Conducts goals of care meetings with patients and families to explain hospice options.
• Educates facilities and referral sources about Hospice programs and services.
• Performs follow-up meetings and phone calls after information visits.
• Maintains and grows referral sources with hospitals, nursing homes and community partners.
• Documents visits and communications with patients, families, and referral sources.
• Coordinates transition of care from hospital to home or admission for hospice, including coordination with admission nurse and Medical Director, meds, and consents.
• Mentors and trains new RNs for high-acuity patient needs.
• Attends Interdisciplinary Care Meetings regarding patients and families in the hospital.
• Establishes relationships with hospital Case Managers, Social Workers, and Physicians.
• Performs additional duties as required, including routine visits and admissions.

Skills

RN licensure

Hospice/home care experience

Hospital coordination

Education for referral sources

Education

Graduate of a professional nursing program

Tools

EMR systems

Job description

St. Croix Hospice is seeking an experienced Hospice Transition Nurse to support patients, families, and hospital partners. The role focuses on education, referrals, and coordinating transition from hospital to home hospice care.

You will manage goals of care meetings, collaborate with hospitals and nursing homes, and mentor other RNs while traveling to patient locations across Wisconsin.