Hybrid Care Transitions Utilization RN – Value-Based Care

Vitae Health Systems; Park Ridge (IL); Hybrid; USD 85,000 - 95,000; Full time

Benefits offered by this job

Competitive salary and benefits пакет

Hybrid work arrangement

Job summary

Vitae Health Systems is seeking an experienced Care Transitions Utilization Nurse (RN) in Park Ridge, IL to manage patient needs during transitions from post-acute settings. The role includes telephonic outreach, discharge coordination, and reducing avoidable utilization, working alongside embedded NPs and reporting to the Executive Director of Value-Based Care Clinical Operations.

This is a hybrid role with one day per week in the Park Ridge office.

Qualifications

• Active, unrestricted RN license in Illinois.
• 5+ years of skilled nursing facility leadership experience.
• Experience with value-based care or care transitions programs.
• Strong communication and telephone triage skills.
• Proficiency with EMR systems and data reporting.

Responsibilities

• Identify ED visits and hospital admissions via ADT feeds and NP notifications; document details.
• Review each event with chart review and provider discussion.
• Escalate cases to clinical leadership when triggers are met.
• Conduct post-discharge telephonic outreach to ensure follow-up care.
• Coordinate with facilities, providers, and caregivers to close care gaps.
• Document encounters using SBAR and maintain review data for trend reports.
• Support SOP development and participate in program maturation.

Skills

Leadership in SNF

Telephonic triage

Care coordination

EMR proficiency

SBAR communication

Data reporting

Tools

EMR systems

Spreadsheets

Review tools

Job description

Vitae Health Systems is seeking an experienced Care Transitions Utilization Nurse (RN) in Park Ridge, IL to manage patient needs during transitions from post-acute settings. The role includes telephonic outreach, discharge coordination, and reducing avoidable utilization, working alongside embedded NPs and reporting to the Executive Director of Value-Based Care Clinical Operations.

This is a hybrid role with one day per week in the Park Ridge office.