Care Transition Nurse

AtParkview Health at Home, we believe in the power of meaningful relationships. As a Care Transition Nurse, you will be the driving force behind establishing and maintaining profitable connections with our valued customers. Your dedication to exceptional service will create a lasting impact on our patients, field staff, and case managers, promoting the excellence of our organization. Join us on this inspiring journey where every contact becomes an opportunity to make a difference.

Parkview Health at Home Now Hiring a Full Time CareTransition Nurse (CTN) based out of Randalia Hospital!

The Care Transition Nurse (CTN) collaborates with physicians, hospitals, nursing homes, home care personnel in the process of providing coordinated quality home care services for patients referred to the company. This activity may be in a health care facility or in the field office location. The Care Transition Nurse observes and reports trends, changes, and new opportunities.  Increases awareness among key contacts at health care facilities when home care is an optimal solution and helps identify when services are appropriate for individual patients. Assists patients in making a seamless transition to home care. 

• Functions in clinical areas which may include neonates, pediatrics, adolescents, adults, and geriatrics.  May interact directly with persons in the age categories of neonate, infant, child, adolescent, adult and geriatric.
• Participates in case conferences, summary reports, quarterly record review, annual program review and in-services or special case orientations.
• When a hospital contracts with the company for the CTN to perform the following services:
1. Presents patient with home care agencies and obtains patient’s signed home care choice form.
2. Arranges home care services for patients regardless of agency selected. 
• Follows referral of a patient to the organization, assists discharge coordinators in coordinating quality home care services for patients in the following manner:
1. Determines patient eligibility for home care services.
2. Effectively communicates with appropriate disciplines involved in the care of potential home carepatients, and provides information and recommendations to organization staff.
3. Develops professional working relationships with health care providers and facilities, generating an open flow of information and support of home care goals; provides value added counsel, teaching and resourceful problem solving.
• Available to all discharge planners, physicians, other hospital personnel and patients to:
1. Analyze eligibility for home care provide general guidance in determining if a patient would benefit from home care services.
2. Explain Medicare and Medicaid guidelines, insurance plan benefits, financing options organization policies, etc.
• Meets with the Director, Operations and company employees to ensure continuity of care for the patient.
• Works independently with limited direct supervision using the guidelines of the Nurse Practice Act, organizational and department policy and procedures, and professional judgment.

• Graduate of an accredited school of nursing. Current RN, LPN, MSW, or BSW license to practice in the state serviced.
• Hospital and/or homecare nursing experience.
• Two years of appropriate nursing experience.  
• Strong assessment, critical thinking, judgment, creativity and decision making skills.
• Excellent communication skills; both verbal and written.
• Strong initiative, vitality, goal orientation and follow through assuring fulfillment of plans.
• Excellent interpersonal
• Emotional composure, maintains professionalism. 
• Education and training competencies
• Obtain and maintain current CPR/BLS certification
• Compliant with appropriate state certification/registration and reorganizational requirements as necessary.
• Knowledge of home care regulations