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Transitional Care Nurse Practitioner

Starlight Healthcare

United States

Remote

USD 80,000 - 100,000

Full time

Yesterday

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Job summary

Starlight Healthcare is seeking a Transitional Care Nurse Practitioner to oversee virtual post-discharge care for patients. The role involves evaluating patients' conditions, managing their care, and collaborating with a multidisciplinary team to ensure optimal outcomes. Candidates should have an active APRN license and experience in hospital settings. Join a rapidly growing organization focused on quality improvement and patient care.

Qualifications

At least 3 years of experience in a hospital or post-hospital setting.
Must have a current, active APRN license.

Responsibilities

Perform initial evaluation and management visits for post-discharge patients.
Participate in interdisciplinary 'Grand Rounds' for high-risk patients.
Identify areas for quality improvement in post-discharge care.

Skills

Team Player

Virtual Care Experience

Education

APRN License

This range is provided by Starlight Healthcare. Your actual pay will be based on your skills and experience — talk with your recruiter to learn more.

Base pay range

$60.00/hr - $75.00/hr

Direct message the job poster from Starlight Healthcare

The Transitional Care Nurse Practitioner is a skilled and experienced clinical professional with comprehensive knowledge of post-transitional care, acute conditions, and treatments. expertise in providing virtual post-discharge care. The Transitional Care Nurse Practitioner will oversee the virtual care of patients in the 30-day window after discharge from an acute setting (hospital or healthcare facility). The Transitional Care Nurse Practitioner will work to deliver the best post-discharge care for patients possible, while ensuring appropriate patient escalations and communication with referring providers and clinical teams. Must be energized by working in a rapidly growing organization, with the agility and resilience to embrace change and rapid cycles of quality improvement.

Responsibilities

Perform initial evaluation and management (E/M) visits that include a comprehensive post-discharge assessment of patients’ medical conditions, medications, functional status, and psychosocial needs. Additional requirements include completing a post-discharge medication reconciliation, providing appropriate disease education, and communicating contingency plans for worsening symptoms.
Perform ongoing patient calls focused on addressing a patient’s acute need or new symptom, diagnosing and managing the patient, and ensuring they receive the appropriate level of care.
Participate in interdisciplinary “Grand Rounds” to discuss patients who are at the highest risk of readmission due to worsening clinical symptoms.
Work with a team of internal care providers, including physicians, other nurse practitioners, registered dietitians, and health coaches.
Serves as a resource for coaches and other healthcare professionals regarding post-discharge care, including medications, wound care, and other relevant topics.
Identifies areas for quality improvement in post-discharge care and implements evidence-based interventions to improve post-discharge outcomes.
Participates in policy development and implementation related to transitional care.
Completes accurate documentation in the patient’s dashboard after each engagement.
Other duties as assigned.

Qualifications

Must have a current, active APRN license, with preference given to those with multiple state licenses; primary interest in the following states - DC, FL, LA, MD, OR, TX, and WA
At least 3 years of experience in hospital or post-hospital setting, with clear understanding of common hospital discharge diagnoses, post-discharge needs, and the medical management required to avoid readmissions
Strong team player, with a desire to work in an interdisciplinary team to provide the best care to patients
Experience working in a virtual care environment a plus

Seniority level

Seniority level
Not Applicable

Employment type

Employment type
Full-time

Job function

Job function
Health Care Provider
Industries
Health and Human Services

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