Post-Discharge Care Nurse

Vetted Solutions; Fairfield (CT); On-site; USD 65,000 - 85,000; Full time

Job summary

Vetted Solutions in Connecticut is seeking a dedicated nurse to provide compassionate follow-up care after hospital or clinic visits. You will conduct in-person and virtual assessments to monitor patient progress and reinforce discharge plans to ensure understanding and adherence.

You will coordinate patient services, identify early signs of complications, document interventions in the EHR, and collaborate with an interdisciplinary care team to optimize care continuity.

Qualifications

• Strong clinical judgment and clear communication are essential.
• Ability to work effectively with multidisciplinary teams.
• Experience documenting assessments and care plans in EHRs.

Responsibilities

• Conduct in-person and virtual follow-up assessments to monitor patient progress.
• Reinforce and support discharge plans, ensuring understanding and adherence.
• Coordinate patient services and connect patients with appropriate resources.
• Identify early signs of complications and elevate concerns promptly.
• Document assessments, interventions, and outcomes in the EHR.
• Collaborate with an interdisciplinary care team to optimize care continuity.
• Educate patients and families on care plans, warning signs, and next steps.

Skills

Clinical assessment

Patient education

EHR proficiency

Team collaboration

Tools

EHR systems

Job description

Revisit Nurse provides compassionate follow-up care for patients after hospitalization or clinic visits, supporting recovery and helping reduce readmissions.

• Conduct in-person and virtual follow-up assessments to monitor patient progress.


• Reinforce and support discharge plans, ensuring understanding and adherence.


• Coordinate patient services and connect patients with appropriate resources.


• Identify early signs of complications and elevate concerns promptly.


• Document assessments, interventions, and outcomes in the EHR.


• Collaborate with an interdisciplinary care team to optimize care continuity.


• Educate patients and families on care plans, warning signs, and next steps.

Strong clinical judgment, clear communication, EHR proficiency, and the ability to work effectively with a multidisciplinary team are essential.