RN Care Transitions Navigator

University Hospitals; Chardon (OH); On-site; USD 68,000 - 93,000; Full time

Job summary

University Hospitals offers an RN Transitional Care Coordinator-Geauga position focused on optimizing post-acute care transitions and patient outcomes. You will assess needs, coordinate with hospital and community resources, and tailor discharge plans to patient and family goals while ensuring PHI protection.

You will collaborate with a multidisciplinary team, document comprehensive plans, and facilitate hand-offs to next care settings, including home health or SNF, ensuring smooth care

Qualifications

• Graduate of an accredited school of nursing.
• 1+ year of clinical nursing experience in acute care.
• Experience with utilization management, case management, post-acute transitions, and home health is preferred.
• RN licensure in Ohio or multi-state compact expected upon hire.

Responsibilities

• Completes assessment of patient’s functioning, resources and plans.
• Collaborates with the multidisciplinary team to coordinate care.
• Provides updates to medical/nursing teams about care plans and transitions.
• Develops and documents discharge plans aligned with patient and family goals.
• Assists with recruitment, orientation and mentoring of new staff.
• Focuses on readmission risk assessments and alternative services when appropriate.
• Connects patients to PCI, ACO, and managed care teams.

Skills

Clinical knowledge

Medicare/Medicaid knowledge

Computer proficiency

Multitasking

Autonomy

Communication skills

Teaching skills

Professional demeanor

Education

RN licensure (Ohio or compact)

Bachelor’s degree (preferred)

Job description

University Hospitals offers an RN Transitional Care Coordinator-Geauga position focused on optimizing post-acute care transitions and patient outcomes. You will assess needs, coordinate with hospital and community resources, and tailor discharge plans to patient and family goals while ensuring PHI protection.

You will collaborate with a multidisciplinary team, document comprehensive plans, and facilitate hand-offs to next care settings, including home health or SNF, ensuring smooth care