About this role
In collaboration with the patient/family, physicians, and the interdisciplinary team, the Transitional Care Nurse Navigator facilitates the patient's progress through the acute episode of care in an efficient and cost effective manner and creates a plan along with patient/family and providers for transition from inpatient setting to post-acute setting. Initiates evidence based protocols and order sets according to the patients admission diagnosis, influencing the progression of care, facilitating the patients' navigation through the acute care episode, and proposes an appropriate transition plan within 48 hours of admission. The Transitional Care Nurse Navigator serves as an advocate for the patient and family throughout the entire care continuum and facilitates communication with the multidisciplinary team, referring physician and ambulatory care team. Fosters patient/family self-management and compliance with individualized plan of care via post-acute phone call.
Education Bachelor's Degree BSN Required
Experience 3 years experience in nursing in an acute care setting Required General Experience Previous experience in a clinical healthcare setting or insurance setting responsible for direct management of patient care; including planning, coordination, discharge planning and delivery of needed services Preferred
Licenses PA Registered Nurse License Required Certified Case Manager Preferred Multi State Compact RN License Required Or