Ensure transition of care between patients and health care providers to confirm continuity and coordination of care for patients at moderate to high risk for readmission to the hospital who are transitioning from hospital to home or another care facility/provider. In collaboration with the interdisciplinary team, is directly involved in the process of assessment, planning, facilitating, monitoring, and evaluation of options and services to meet an individual patientâ€™s health care needs. Participates in the promotion of quality outcomes, patient satisfaction, and cost-effective care delivery. Utilizes knowledge of the principles of growth and development appropriate to the patientâ€™s age to ensure the bedside care provided meets the unique, physical and psychosocial needs of the patient.
MINIMUM KNOWLEDGE, SKILLS & ABILITIES
BSN required with 3 years of clinical experience, including discharge planning and transition of care. RN license within the State of New Jersey. Knowledge of managed care, government payers and third-party reimbursement. Case Management Certification a plus. Skills: Knowledge of EDIS, SoftMed, Soarian and utilization of MS Office applications. Developing and maintaining strong interpersonal relationships. Problem solving skills Decision making skills Ability to: Perform bedside teaching on medication, disease process and follow- up care to patient and family. Handle multiple tasks and projects simultaneously. Collaborate with others to meet multiple deadlines. Communicate effectively orally and in writing. Document in an electronic health records.
Jefferson Health delivers state of the art healthcare services to patients throughout the Delaware Valley and southern New Jersey. Jefferson (Philadelphia University + Thomas Jefferson University) provides more than 8,400 full and part-time students from nearly 40 states and 40 countries with 21st century professional education. Combined, we have over 30,000 employees.
Jefferson Health, with 14 hospitals (seven are Magnet designated by the ANCC for nursing excellence) and 40+ outpatient and urgent care locations, offers a broad range of primary and complex, highly specialized care that touches the lives of more than four million patients annually. U.S. News & World Report has ranked Thomas Jefferson University Hospital among the nation’s best in eight specialties. Jefferson Health also includes the NCI designated Sidney Kimmel Cancer Center; it is one of only 70 such centers in the nation.
Thomas Jefferson University has ten colleges and three schools that offer more than 160 undergraduate and graduate programs. Our University is dedicated to inter-professional and transdisciplinary approaches to learning that offer a vibrant and expandable platform for professional education. Through this unique model, we are preparing our students for current and yet to be imagined careers.
As an employer, Jefferson maintains a commitment to provide equal access to employment. Jefferson values diversity and encourages applications from women, members of minority groups, LGBTQ individuals, disabled individuals, and veterans.