Specialist Care Transitions-SCH-PRN-Days

This role involves overseeing patient transition from the acute care setting to their appropriate discharge plan, ensuring safe and appropriate care delivery. The Specialist Care Transitions nurse will collaborate with other departments and coordinates patient needs and regulations. They actively monitor the patient’s progress and implement treatment adjustments to meet their goals.

Requirements

• Comprehensive patient/family assessment
• Identification of patient needs and referrals
• Implementation of transition of care plan
• Communication with medical and nursing staff
• Documentation of discharge plan
• Coordination of patient transfer
• Compliance with CMS guidelines
• Resolution of potential barriers to discharge