Registered Nurse Triage and Transition

Intermountain Healthcare Inc.; United States; On-site; USD 49,000 - 73,000; Full time

Job summary

Intermountain Health in Colorado seeks an RN Transition and Triage Care Manager to provide time-limited, patient-centered care coordination across settings via telephone and digital communications.

The role identifies high-risk patients, plans and coordinates with hospitals, clinics, and community resources, and guides appropriate care levels, with office hours in Pacific Time and ambulatory care experience preferred.

Qualifications

• Current RN license in state of practice.
• BSN from an accredited institution; BSN to be obtained within 4 years of hire/promotion.
• Demonstrated clinical nursing experience in chronic disease management; familiarity with chronic disease terminology and processes.
• Understanding of disease management including treatment, length of stay, barriers to delivery of care, and variation.
• Basic computer skills and knowledge of Microsoft Office software.
• Minimum of 2 years of nursing experience (no new grads).
• BSN to be obtained within four years of hire or promotion.

Responsibilities

• Identifies patients for proactive interventions using screening criteria, medical record review, payor models, medical risk scores, or referrals.
• Develops individualized care plans and referrals based on assessment.
• Coordinates with internal/external services for social determinants of health needs and community care.
• Evaluates and modifies the plan of care or interventions as needed.
• Conducts remote nursing assessments and triage using evidence-based protocols.
• Supports patient self-management through health coaching and care navigation.
• Educates patients and families about conditions and self-management.
• Collaborates with physicians and care team to ensure timely, quality care.
• Performs data analysis to improve transitions of care and reduce duplications.

Skills

Care Planning

Transitions of Care

Motivational Interviewing

Critical Thinking

Time Management

Customer Service

Patient Education

Communication

Prioritization

Education

BSN from an accredited program

RN license

Job description

Job Description

The RN Transition and Triage Care Manager offers comprehensive, time-limited services to patients and their families, ensuring continuity of care as they move across healthcare settings and clinicians. This role aims to prevent health complications, connect patients to resources, and guide them to the appropriate level of care. Utilizing clinical expertise, technology, and evidence-based practices, the manager assesses, plans, implements, and evaluates patient care through telephone or digital communication methods. Effective collaboration with patients, families, healthcare providers, payers, community-based providers, and other involved parties is essential to deliver efficient, effective, and patient-centered care management services. The manager operates in various settings, including triage, transitions of care, clinics, communities, and post-acute care environments. Position specifics: This position requires office hours to be Pacific time zone and strongly prefer ambulatory care experience in a primary care clinic, telephone triage, or telephonic nursing.

Essential Functions

• Patient Identification and Assessment: Identifies patients for proactive interventions using specific screening criteria, medical record review, payor models, medical risk scores, or referrals. Assesses patients' medical, functional, and social conditions per department policy/guidelines to develop individualized care plans, care recommendations, or referrals as appropriate.
• Care Plan Management: Coordinates with internal and external services for social determinants of health (SDoH) needs and care in the community. Evaluates the effectiveness of the patient’s care plan and outcomes. Modifies the plan of care or specific interventions, as appropriate.
• Acute Symptom Triage: Conducts remote nursing assessments. Utilizes critical thinking skills to assess patient symptoms, medical history, and concerns, applying evidence-based protocols to determine appropriate care recommendations.
• Patient Support: Supports patient self-management and behavior change through health coaching, care navigation, care coordination, and education of identified patient/caregiver/family to identify and address barriers to optimal health outcomes.
• Education and Advocacy: Educates healthcare team members about transitions and triage processes, appropriate referrals, and advocate for patient rights. Educates patients about their medical/behavioral health conditions and self-management.
• Multidisciplinary Collaboration: Collaborates with physicians and other healthcare team members on the patient’s behalf to ensure patient receives quality and timely care and resolve any delays or issues. Participates in rounds or case conferences when necessary. Utilizes team-based care approach referring and consulting with social work, nutrition, pharmacy, rehabilitation, behavioral health, etc. resources as appropriate.
• Relationship Building: Develops and maintains collaborative partnerships with hospital care management, post-acute providers, and other care managers to ensure seamless transitions and continuity of care. Avoids duplicative care management services/programs.
• Process Improvement: Actively participates in system and regional initiatives to improve transitions of care and avoid duplicative services.
• Data Analysis: Conducts root cause analysis of extended post-acute stays, inappropriate utilization, readmissions, and track key data elements or metrics. Identifies, analyzes, and monitors industry, regulatory, technology, and market-based trends that impact ambulatory and post-acute services.

Skills Assessment

• Care Planning
• Transitions of Care
• Motivational Interviewing
• Critical Thinking
• Time Management
• Customer Service
• Patient Education
• Communication
• Prioritization

Minimum Qualifications

• Current Registered Nurse (RN) license in state of practice.
• Bachelor of Science in Nursing (BSN) from an accredited institution (degree verification required).
• RNs hired or promoted into this role must obtain their BSN within four (4) years of hire or promotion date.
• Demonstrated clinical nursing experience in chronic disease management, and familiarity with chronic disease terminology and processes.
• Demonstrated understanding of disease management including treatment, length of stay, identifying barriers to delivery of care and any variation.
• Basic computer skills and knowledge of Microsoft Office software.
• A minimum of 2 years of nursing experience (no new grads at this time).

Preferred Qualifications

• Bachelor of Science in Nursing (BSN) from an accredited institution.
• Care Management Certification.
• Experience in ambulatory transitional of care or telephonic triage.
• Intermediate computers skills and knowledge of Microsoft Office software.

Physical Requirements

• Ongoing need for employee to see and read information, labels, assess patient needs, operate monitors, identify equipment and supplies.
• Frequent interactions with patient care providers, patients, and visitors that require employee to verbally communicate as well as hear and understand spoken information, alarms, needs, and issues quickly and accurately, particularly during emergency situations.
• Manual dexterity of hands and fingers to manipulate complex and delicate equipment with precision and accuracy. This includes frequent computer use and typing for documenting patient care, accessing needed information, medication preparation, etc. May be expected to stand in a stationary position for an extended period of time.
• For roles requiring driving: Expected to drive a vehicle which requires sitting, seeing and reading signs, traffic signals, and other vehicles.

Location & Working Hours

• Location: Peaks Regional Office. Work City: Broomfield. Work State: Colorado.
• Scheduled Weekly Hours: 40.
• The hourly range for this position is listed below. Actual hourly rate dependent upon experience: $35.22 - $53.29.

Benefits

We care about your well-being - mind, body, and spirit - which is why we provide our caregivers a generous benefits package that covers a wide range of programs to foster a sustainable culture of wellness that encompasses living healthy, happy, secure, connected, and engaged. Learn more about our comprehensive benefits package here.

Policies

By applying for a position with Intermountain, I acknowledge that I will comply with all applicable Intermountain policies and expectations. If applying for a remote or hybrid role, this includes remote work expectations related to confidentiality, information security, work schedules, conflicts of interest, and use of company equipment. I further acknowledge that outside employment or activities may not interfere with job responsibilities or create a conflict of interest with Intermountain. Actual or reasonably perceived conflicts may be grounds for disqualification from consideration or, if hired, corrective action up to and including termination of employment.

Equal Opportunity Statement

Intermountain Health is an equal opportunity employer. Qualified applicants will receive consideration for employment without regard to race, color, religion, age, sex, sexual orientation, gender identity, national origin, disability or protected veteran status.

Company Overview

Headquartered in Utah with locations in six primary states and additional operations across the western U.S., Intermountain Health is a nonprofit system of 34 hospitals, 400+ clinics, a medical group of more than 4,800 employed physicians and advanced care providers, a health plan division called Select Health with more than one million members, and other health services. Helping people live the healthiest lives possible, Intermountain is widely recognized as a leader in clinical quality improvement and efficient healthcare delivery. Join our world-class team and embark on a career filled with opportunities, strength, innovation, and fulfillment.

PEAK Program

Intermountain Health's PEAK program supports caregivers in the pursuit of their education goals and career aspirations by providing up-front tuition coverage paid directly to the academic institution. The program offers 100+ learning options to choose from, including undergraduate studies, high school diplomas, and professional skills and certificates. Caregivers are eligible to participate in PEAK on day 1 of employment. Learn more.

Additional Information

The primary intent of this job description is to set a fair and equitable rate of pay for this classification. Other duties may be assigned by the supervisor. All positions subject to close without notice.