Registered Nurse, RN Care Transition Manager – FT

Texas Health Resources•Fort Worth, TX

2d•Onsite

About The Position

Texas Health Harris Methodist Hospital Alliance is a 151-bed, full-service hospital offering acute care and wellness programs to communities in North Fort Worth, Keller, North Richland Hills, Haslet, Justin, and surrounding areas. The hospital provides numerous services, including emergency medicine, general and outpatient surgery – including an outpatient surgery center, women, and infant’s care – including a level III neonatal intensive care unit, radiology – including a women’s imaging center, cardiac rehabilitation and therapy center, business health services, and wellness programs. Texas Health Alliance is a technologically advanced hospital that has earned national recognition for operating at the highest level of electronic medical record adoption. We invite you to join us in furthering your career through our accomplishments and philosophy of excellence.

Requirements

Bachelor's Degree Nursing
3 years of Staff Nurse at an acute care hospital is required.
Must hold an active RN license - Registered Nurse Upon Hire is required.
CPR – Cardiopulmonary Resuscitation is required upon hire.

Nice To Haves

1 year of discharge planning and/or care management is highly preferred.
ACM – Accredited Case Manager upon hire is preferred OR CCM – Commission for Case Manager Certification or other ANCC upon hire is preferred.

Responsibilities

Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner.
Completes Transition Evaluations and collects Social Determinants of Health (SDOH) data on patients within 48 hours of identification and begins discharge planning.
Assesses and interviews patient and caregivers as part of this evaluation and as needed.
Reviews the Risk of Unplanned Readmission (RUR) scores daily for all assigned patients.
Assists in the identification of a primary care physician (PCP) for patients without a PCP and attempts to schedule follow up appointments with either a PCP, specialist, clinic, physician or other transitional care visit prior to discharge.