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RN - Transition of Care Nurse
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Full-time
- Responsibilities Prominence Health is a value-based care organization bridging the gap between affiliated health systems and independent providers, building trust and collaboration between the two.
- Learn more at: Job Summary: Under the supervision of the Transition of Care Clinical Program Manager, The Transition of Care (TOC) Nurse is responsible for managing a member’s successful transition from an acute or post-acute level of care to home and is accountable for developing, implementing, and evaluating comprehensive transitional care interventions for high risk medical and/or surgical members for Prominence Health.
- He/she is responsible for facilitating the post-acute care of members that are at risk for poor health outcomes, frequent emergency room visits, and hospital readmissions.
- This includes a focus on medication reconciliation and adherence, management of member’s quality of life and functionality, management of both acute and chronic disease states, identification and rectifying gaps in care, support of member’s ability to perform self-cares, coordination of post-discharge appointments and services (durable medical equipment, home health), and coordination of care across the care continuum.
- Active, unrestricted, current, and valid Registered Nurse licenses in the States of Practice (Nevada, Texas and/or Florida), required Certified Case Manager (CCM), Case Management Nurse – Board Certified (CMGT-BC), Accredited Case Manager – RN (ACM-RN), or Certified Managed Care Nurse (CMCN), Minimum of three years in clinical nursing practice, required.
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