Registered Nurse - Admissions - Continuum of Care

It's more than a career, it's a calling

WI-St Francis Home

Worker Type:

Regular

Job Highlights:

Join a team where your work matters—every moment, every patient, every community. At SSM Health, you'll be empowered to grow, supported to thrive, and inspired to make a lasting impact.

The role will help to ensure a smooth transition for rehab residents (admissions orders, documentation, assessments, etc) and will handle additional functions such as infection prevention.

Department: Long Term Care

Schedule: Full time M-F

Apply today. SSM Health – We bring out the incredible in you, everyday.

Job Summary:

Reviews and analyzes resident referrals to determine the appropriateness of long-term care and infusion services. Coordinates all aspects of service to optimize the resident’s smooth transition from hospital to long term care. Communicates key components of resident’s needs and physicians' orders to clinicians to help establish the resident’s plan of care. Provides educational information to case managers, physicians, key hospital staff, and nursing home staff regarding qualifying criteria, access to services, etc.

Job Responsibilities and Requirements:

PRIMARY RESPONSIBILITIES

• Assesses resident care needs by gleaning hospital records and/or referral provided information for information necessary to determine the appropriateness of referral and to initiate resident records.

• Identifies educational needs for residents/significant others.

• Adheres to skilled service regulations of payers.

• Plans for resident care by ensuring that information regarding pending referrals is passed on to nursing supervisors, clinical supervisor or rehab services, and others as necessary in a timely manner.

• Coordinates with nursing supervisors, clinical supervisor or rehab services, and others in initiating care.

• Seeks appropriate orders in planning multidisciplinary care.

• Completes evaluation of care by reassessing residents systematically to identify progress and trends that require intervention; this may include seeing the re-hospitalized resident and/or reviewing their record.

• Communicates with supervisor regarding the cases he/she is managing while awaiting the initiation of care.

• Assesses and discerns environmental factors which are hazardous and/or unsafe and responds according to policy and agency expectation.

• Works in a constant state of alertness and safe manner.

• Performs other duties as assigned.

EDUCATION

• Graduate of accredited school of nursing or education equivalency for licensing

EXPERIENCE

• One year experience

PHYSICAL REQUIREMENTS

• Constant use of speech to share information through oral communication.

• Constant standing and walking.

• Frequent lifting/carrying and pushing/pulling objects weighing 0-25 lbs.

• Frequent sitting, reaching and keyboard use/data entry.

• Frequent use of vision and depth perception for distances near (20 inches or less) and far (20 feet or more) and to identify and distinguish colors.

• Frequent use of smell to detect/recognize odors.

• Frequent use of hearing to receive oral communication, distinguish body sounds and/or hear alarms, malfunctioning machinery, etc.

• Occasional lifting/carrying and pushing/pulling objects weighing 25-50 lbs.

• Occasional lifting/moving of patients.

• Occasional bending, stooping, kneeling, squatting, twisting, gripping and repetitive foot/leg and hand/arm movements.

• Occasional driving.

• Rare crawling and running.

REQUIRED PROFESSIONAL LICENSE AND/OR CERTIFICATIONS 

Work Shift:

Day Shift (United States of America)

Job Type:

Employee

Department:

1800000068 SNF St Francis

Scheduled Weekly Hours:

40

SSM Health is an Equal Opportunity Employer. SSM Health provides equal employment opportunities to all employees and applicants for employment without regard to race, color, religion, sex, gender, pregnancy, sexual orientation, gender identity, national origin, age, disability, protected veteran status, genetic information, or any other characteristic protected by applicable federal, state, or local law. Click here to learn more.