Care Transition Manager RN Full-time

Here’s What You Need

·        Bachelor of Science in Nursing (BSN) required; 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.

·        Current RN licensure or compact licensure recognized by the Texas Board of Nursing upon hire

·        CPR – Cardiopulmonary Resuscitation upon hire Required.

·        3 Years Staff Nurse (RN) at an acute care hospital Required 

·        1 Year discharge planning/care management preferred

·        ACM – Accredited Case Manager Upon Hire Preferred Or
CCM – Certified Case Manager Upon Hire Preferred Or
Other ANCC Upon Hire Preferred

·        Working knowledge of medical necessity criteria preferred
Knowledge of Microsoft Outlook and Office (Word, Excel)
Customer service skills; Ability to engage in complex clinical decision-making
Strong oral and written communication skills
Strong commitment to interdisciplinary collaboration
Critical thinking, analysis and conflict resolution skills
Flexible scheduling as necessary
Psychosocial and crisis intervention skills
Ability to prioritize and meet deadlines

 

What You Will Do:

·        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.

·        Identifies community resources and service needs and facilitates appropriate referrals as needed, while also providing education to patients, caregivers, and the multidisciplinary team regarding the available post-acute care services and needs.

·        Assists with referrals for community resources and service needs including housing, food, transportation, and other social and environmental issues affecting health.

·        Serves as a content expert regarding payor information.

·        Educates the multidisciplinary team, patients and caregivers regarding payor requirements and barriers.

·        Communicates with payors as needed to coordinate care.

·        Responsible for compliance with documentation guidelines and regulatory agency requirements.

·        Complies with all documentation requirements and documents all activities in the electronic health record.

·        Adheres to compliance requirements for delivery of various documents (e.g. HINN, IMM, MOON letters).

·        Has a working knowledge of the following documents: Advanced Directives, Medical Power of Attorney, Application for Temporary Mental Health Treatment, and out-of-hospital Do Not Resuscitate.

 

Additional perks of being a Texas Health Care Transition Nurse

·        Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flexible spending, tuition reimbursement, student Loan repayment program, as well as several other benefits.

·        A supportive, team environment with outstanding opportunities for growth.

·        Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more.

Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth.org.

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