Specialist Care Transitions-FT/Days

This role focuses on the clinical aspects of determining appropriate discharge plans for patients in the acute care setting. The specialist care transitions nurse will facilitate and coordinate a safe discharge plan while adhering to patient needs, state/federal regulations, and the patient's individual needs. This position involves collaboration with other disciplines and a discharge plan implementation process.

Requirements

• Coordinate patient care from admission to discharge.
• Conduct a comprehensive patient/family assessment.
• Identify barriers and provide clarity for realistic goals.
• Collaboration with IDT clinical team to develop transition of care plan.
• Monitor and re-evaluate treatment plan modification.