RN Care Transition Specialist

Fairview Health Services•Edina, MN

3h•Onsite

About The Position

M Health Fairview Health Services is searching for a hardworking and enthusiastic RN who is looking for an exciting career in our busy Care Management Department located at our Edina, Minnesota campus! Fairview Southdale Hospital offers care to people living and working in the southwest Twin Cities metro area. With more than 40 specialty services, we combine talents to balance innovative technologies and treatments with the art of medicine. Working together, we respectfully address the comprehensive needs of our patients and their families. This Care Transitions Specialist-RN provides comprehensive care coordination of patients as assigned. The care coordinator assesses the patient's plan of care and develops, implements, monitors and documents the utilization of resources and progress of the patient through their care, facilitating options and services to meet the patient's health care needs. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for the quality of clinical services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. This position has responsibility to determine how to best accomplish functions within established procedures, consulting with leader on any unusual situations. Internal customers include all levels of nursing management and staff, medical staff, and all other members of the interdisciplinary health care team. External customers include physicians and their office staff, payers, community agencies, provider networks and regulatory agencies.

Requirements

MN Registered Nurse (RN) License
Basic Life Support (American Heart Assoc or Red Cross)
Three to five years of current RN acute care clinical experience

Nice To Haves

Bachelors Degree in Nursing
5 years experience
1+ years working as a care coordinator/case manager

Responsibilities

Assesses patient needs and identifies expected nursing outcomes.
Collaborates with patient, family and other health team members to develop a nursing plan as part of an integrated, comprehensive plan of care
Develops an individualized plan based on age, social and cultural considerations, condition and other relevant needs.
Evaluates care and patient response to interventions and expected outcomes.
Collaborates and communicates effectively and respectfully with the patient, family and members of the health care team within and across care settings to promote partnership-based healthcare
Demonstrates the ability to advance care by utilizing standards, guidelines, care pathways and continuous improvement to enhance patient outcomes.
Promotes a culture of evidence based practice (EBP)