Transitional Care RN: Patient Advocate & Care Transitions Expert

Dartmouth-Hitchcock Health; New London (NH); Vor Ort; USD 70.000 - 90.000; Vollzeit

Zusammenfassung

Dartmouth-Hitchcock Health is seeking a Transitional Care RN to ensure safe and effective patient transitions across the care continuum at New London Hospital Medical Group. You will educate, advocate, and empower patients and caregivers, improving self-management and communication with the healthcare team.

Responsibilities include participation in discharge planning, information delivery to patients, interdisciplinary collaboration for safe transition plans, advocacy for patient resources,

Qualifikationen

• Graduate of an accredited School of Nursing.
• 3 to 5 years related experience.
• Case Management certification from accredited organization strongly preferred.
• Licensed RN with NH eligibility

Aufgaben

• Attends discharge planning meetings. Reviews the patient’s medical record and gathers clinical information from the current care delivery team and patient.
• Provides information to patients and caregivers about NLH post acute discharge plans.
• Collaborates with all members of the interdisciplinary team to develop a safe transitional plan to the next level of care. Ensures all clinical and personal transitional goals are met throughout.
• Advocates on behalf of the patient and the healthcare provider for needed patient resources and services.
• Provides written communication to the receiving clinician as the patient transitions from one level of care to the next. Contacts the patient’s PCP with each transition of care, providing a summary of the patient’s clinical status. Collaborates with the PCP to provide direction to enhance the effectiveness of the healthcare delivery team, including transitions across physical settings and to monitor and manage changes in health status.
• Maintains excellent documentation of patient encounter records. Enters specified data elements into electronic dashboard with each patient transition or discharge.
• Develops and maintains plan of care for NLH-based patients.

Kenntnisse

Experience

Ausbildung

Nursing degree

Jobbeschreibung

Dartmouth-Hitchcock Health is seeking a Transitional Care RN to ensure safe and effective patient transitions across the care continuum at New London Hospital Medical Group. You will educate, advocate, and empower patients and caregivers, improving self-management and communication with the healthcare team.

Responsibilities include participation in discharge planning, information delivery to patients, interdisciplinary collaboration for safe transition plans, advocacy for patient resources,