Remote Transitional Care RN for High-Risk Patients

Aurora Health Care; Allenton (WI); Hybride; USD 90 000 - 120 000; Plein temps

Résumé du poste

Aurora Health Care is seeking a skilled RN for a transitional care role focused on high-risk patients during discharge and the 30‑day period. You will assess medical, psychosocial, and environmental factors, and craft patient-centered care plans with emphasis on medications and follow-up.

The role requires strong coordination with inpatient teams, primary care, home health, and community resources, plus excellent communication and telehealth capabilities to monitor patient progress.

Qualifications

• RN must hold active, unrestricted license.
• Minimum of five years of clinical nursing experience in acute/discharge planning/post-acute/transitional care.
• Bachelor of Science in Nursing required; Master’s degree preferred.

Responsabilités

• Conduct comprehensive clinical assessments of high-risk patients at discharge and during 30-day transition.
• Develop and update individualized care plans addressing clinical needs and follow-up.

Connaissances

Clinical nursing

Care coordination

Communication skills

Telehealth familiarity

EHR proficiency

Leadership

Patient education

Formation

BSN

MSN preferred

Outils

EHR software

Care coordination tools

Telehealth platforms

Description du poste

Aurora Health Care is seeking a skilled RN for a transitional care role focused on high-risk patients during discharge and the 30‑day period. You will assess medical, psychosocial, and environmental factors, and craft patient-centered care plans with emphasis on medications and follow-up.

The role requires strong coordination with inpatient teams, primary care, home health, and community resources, plus excellent communication and telehealth capabilities to monitor patient progress.