Registered Nurse, RN Care Transitions Manager – PRN

Texas Health Resources•Denton, TX

5d•Onsite

About The Position

Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner. At Texas Health Denton we take seriously our mission to improve the health of those in our community. We are a 255-bed, full-service hospital serving our community since 1987. Our central location provides convenient care to people in the DFW Metroplex and across North Texas and Oklahoma. With more than 1,000 employees and 450+ physicians on our medical staff we are one of Denton County’s largest employers. Texas Health Denton is a Joint Commission-accredited Primary Stroke Center and Chest Pain Center and a Bariatric Surgery Center of Excellence and a Pathways to Excellence-designated hospital. We are the only choice in Denton for oncology.

Requirements

Bachelor's Degree Nursing Individuals hired as CTRN prior to May 11, 2017, will be grandfathered to the CTRN position with an RN, at the entity they were employed at on May 11, 2017.
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 is preferred upon hire.
CCM - Certified Case Manager is preferred upon hire.
Other ANCC is preferred.

Responsibilities

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.