RN Post-Acute Care Navigator

University Hospitals; Willoughby (OH); On-site; USD 70,000 - 90,000; Full time

Job summary

University Hospitals in Willoughby, OH seeks an RN Transitional Care Coordinator-Lake West to coordinate post-acute care plans and ensure appropriate next site of care using evidence-based tools.

You will collaborate with the care team, families, and support systems, develop discharge plans, address barriers to follow-up, and facilitate hand-offs to home health, SNF, IRF or other facilities.

Qualifications

• Graduate of an accredited school of nursing (Required).
• Bachelor's Degree (Preferred).
• 1+ years clinical nursing experience (acute care) (Required).
• Experience in utilization management, case management, post-acute transitions, and home health (Preferred).

Responsibilities

• Completes assessment including patient's previous level of functioning and resources.
• Communicates with multidisciplinary team to coordinate care.
• Updates medical team on plan of care for discharge or movement to alternate site.
• Develops discharge plan aligned with patient and family goals.
• Assist with recruitment and mentoring of new staff.
• Focus on readmission assessments and intercept programs for non-admit patients.
• Connects patients to PCI, ACO, and Managed Care teams.

Skills

Clinical knowledge

Regulatory knowledge

Computer skills

Multitasking

Autonomy

Communication

Teaching

Professionalism

Education

Nursing degree (RN)

Bachelor's degree (preferred)

Job description

University Hospitals in Willoughby, OH seeks an RN Transitional Care Coordinator-Lake West to coordinate post-acute care plans and ensure appropriate next site of care using evidence-based tools.

You will collaborate with the care team, families, and support systems, develop discharge plans, address barriers to follow-up, and facilitate hand-offs to home health, SNF, IRF or other facilities.