- Assess and help coordinate treatment interventions and transition planning. When appropriate, present transition options to physician and care team to avoid hospitalization
- Identify and target high-risk and high-utilizing patients and assist in meeting needs to avoid hospitalization.
- Determine level of care partnering with care team (ED MD, RN, Hospitalist, Care Consultant &/or HCH RN) to construct quality and safe care plan
- Collaborate with staff at Skilled Nursing Facilities and Assisted Living Residences, particularly our Post-Acute Care Network, to accept patients on short-notice
- Work in direct collaboration with Emergency care Social Worker
- Provide education to patients and families regarding the financial implications of “Outpatient Observation”, including delivery of informational brochure and obtaining patient signature when appropriate
- Assess for financial barriers and collaborate with Patient Financial Services to provide interventions. Provide discharge follow-up phone calls for designated patients
- Cross-cover in Utilization Management and Acute Care
- Current RN License
- Associates required, Bachelors preferred.
- Three or more years of hospital-based acute care nursing experience
- Two years’ experience in any of the following areas: utilization management, case management, and home care setup, discharge planning
On Time Talent Solutions