RN - Transition of Care

Registered Nurse- Transition of Care 100% Remote VillageCare is looking for a self-motivated and passionate RN for our Full Time Transition of Care opening. The Transition of Care Nurse is responsible to ensure safe and effective transfer in the movement of Members across the care continuum, serving as a bridge between professional staff in the care setting (hospital, physician, and outpatient service) and the Member family. Some daily responsibilities will include: • Conduct telephonic assessments of Member status and identified risk for recurring hospitalization. • Evaluate discharge plan and appropriateness of discharge status, in coordination with the UM department and Care Manager. • Develop and utilize assessments, workflows, and standards of care, to evaluate clinical status, at the time of hospital discharge and up to 30 days post discharge. • Serve as a guide to the Member, addressing critical issues - including coaching and guidance to promote better understanding of healthcare issues and ongoing care needs. • Evaluate all aspects of Member condition to formulate a plan leading to medication reconciliation, follow-ups and referrals. • Develop and follow workflows for Chronic Care Improvement program and participate, as needed with Quality Improvement program We would like to speak to those who have a valid NYS RN License along with 3+ years job related experience in Managed Care, Home Care or Community setting. Bachelor of Science Nursing Degree required. Passionate attitude, communication skills and problem solving will be vital to this position. Must reside within the New York Tri-State Area - NY, NJ, or CT. There are many benefits to working for VillageCare. If you are someone who likes being part of a team, enjoys a highly competitive benefits package from world leading carriers and competitive compensation, than we would love to speak with you! • PTO package, 10 Paid Holidays, Personal and Sick time, Medical/Dental/Vision, HRA/FSA, Education Reimbursement, Retirement Savings 403(b), Life & Disability, Commuter Benefits, Paid Family Leave, Additional Employee Discounts VillageCare offers a wide range of at-home and community-based services, as well as managed long-term care options that seek to match each individual's needs to help them attain and maintain the greatest level of independent living possible. We are committed to superior outcomes in quality health care. VillageCare is an Equal Opportunity Employer. Job Posted by ApplicantPro Apply Job!