Registered Nurse Post Acute Transition Specialist

Job Description

Job Description

Join our organization and discover a workplace where team members are valued and trusted. Advance your career with a company dedicated to providing respectful and compassionate care, recognizing the unique worth of every individual. We invite you to apply for the following position: Registered Nurse Post Acute Transition Specialist for our Hospice and Home Care Team, centralized at Mission Main Hospital.

Job Summary and QualificationsPosition Overview:

The role of the Post-Acute Transition Specialist involves acting as a liaison between internal and external referral sources and the CarePartners Post-Acute Service Lines. This specialist is tasked with building relationships, offering education, and fostering collaboration with hospitals, skilled nursing facilities, assisted living centers, ambulatory and inpatient care managers, physicians, payors, MHP CIN, and other community referral sources. The specialist will ensure suitable patient placements through screenings and assessments in partnership with SNF Discharge Planners, Inter-Disciplinary Teams, Ambulatory Care Managers, MHP Care Managers, BPCI Transitions Care Coordinators, practice referral coordinators, physicians, and the CarePartners Post-Acute service line team.

Working closely with Post-Acute providers, SNFs, and physician practices within the clinically integrated network (CIN), as well as hospital care managers and the Mission Palliative Care team, the Post-Acute Transition Specialist will facilitate a seamless referral and admission process for CarePartners Post-Acute programs. Collaboration with health system and community colleagues is essential to ensure quality-driven best practices throughout the continuum of care, utilizing key care management activities in direct patient interactions. The role aims to enhance positive financial outcomes for specific patient populations by intervening at critical points in the disease process, facilitating appropriate Post-Acute placements, engaging in Goals of Care/Advanced Care Planning discussions, and ensuring effective transitions to minimize readmissions and reduce overall care costs through optimal use of Post-Acute services.

Position Requirements:

Minimum Qualifications:

• Licensed professional in a clinical healthcare specialty (e.g., RN, Physical Therapist, Occupational Therapist, or Speech Therapist).
• Current state licensure in the relevant clinical practice area or eligibility for state license transfer.
• Graduate from an accredited institution in the clinical specialty.
• At least 2 years of recent clinical care experience.
• Professional appearance.
• Strong verbal, written, and persuasive communication abilities.
• Basic computer and typing skills (minimum 25 wpm).
• Ability to collaborate effectively with others to ensure quality patient care.
• Excellent organizational and time management skills.
• Robust problem-solving capabilities.
• Strong interpersonal skills.
• Commitment to maintaining excellence in the work environment.

Preferred Qualifications:

• BCLS certification (AHA).
• Successful completion of CARE tool credentialing, when available via UDS.
• If RN, CRRN preferred or to be obtained within 2 years of accepting the position.
• Clinical experience in managing Inpatient Rehabilitation patients.
• Experience as a clinical liaison coordinating admissions for inpatient rehabilitation is preferred.
• Ability to remain persistent and persuasive in challenging situations.
• Capability to analyze data related to referral opportunities.
• Proficient in strategic planning and goal setting.
• Ability to cultivate strong relationships with referral sources while being engaging, accountable, and responsive.
• Self-motivated with strong problem-solving skills.
• Ability to navigate medical records to determine medical necessity for IRF admissions.
• Skill in analyzing clinical data concerning diagnoses and comorbidities to present a comprehensive medical picture of patients.
• Experience in discussing medical terminology with physicians, case managers, and therapists regarding disease states, comorbidities, and patient care.
• (DL) Driver License.
• Bachelor's Degree or Master's Degree.

Experience Requirements:

2 years of experience is required.

Benefits

Our organization provides a comprehensive rewards package that supports the health, life, career, and retirement of our team members. The available plans and programs include:

• Comprehensive benefits for medical, prescription drugs, dental, vision, behavioral health, and telemedicine services.
• Wellbeing support , including free counseling and referral services.
• Time away from work programs for paid time off, paid family leave, long- and short-term disability coverage, and leaves of absence.
• Savings and retirement resources , including a 401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service), Employee Stock Purchase Plan, flexible spending accounts, preferred banking partnerships, retirement readiness tools, rollover support, and financial wellbeing counseling.
• Education support through tuition assistance, student loan assistance, certification support, dependent scholarships, and a partnership with Galen College of Nursing.
• Additional benefits for fertility and family building, adoption assistance, life insurance, supplemental health protection plans, auto and home insurance, legal counseling, identity theft protection, and consumer discounts.

Note: Eligibility for benefits may vary by location.

Our organization is a healthcare provider serving western North Carolina, offering a full range of post-acute care services. Located in Asheville, North Carolina, our services include a Rehabilitation Hospital, Home Health, Outpatient Rehabilitation, Hospice, Palliative Care, Private Duty, PACE (Program of All-Inclusive Care for the Elderly), and Orthotics & Prosthetics. With over 1,200 team members and 400 volunteers, we are dedicated to helping individuals in western North Carolina lead fulfilling lives despite illness, injury, disability, or aging-related challenges.

We have been recognized multiple times as one of the World’s Most Ethical Companies® by the Ethisphere Institute. In recent years, we have invested approximately $3.7 billion in charitable care, uninsured discounts, and other uncompensated expenses.

‘There is so much good to do in the world and so many different ways to do it.’ - Dr. Thomas Frist, Sr.
Co-Founder

If this opportunity resonates with you, we encourage you to apply for the Registered Nurse Post Acute Transition Specialist position. We review applications promptly, and highly qualified candidates will be contacted directly by our team. We are conducting interviews - apply today!

We are an equal opportunity employer and do not discriminate based on race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.