Transitional Care Nurse
Company: Alden Estates of Naperville
Posted on: June 25, 2022
- Responsible for overseeing the coordination of care, day to day
operations of the post- acute programs and services to all
transitional care patients. This includes assessing the
effectiveness and the needs of the programs, development, and
planning of services, organizing, and coordinating the
implementation of services, monitoring, and evaluating the
effectiveness and efficiency of the programs and services. The
Transitional Care Nurse is accountable for maintaining compliance
with current federal, state, and local standards, guidelines and
regulations, facility policies, and as directed by Alden Management
- Demonstrated success in external marketing to physicians,
discharge planners and other healthcare referral sources
- Prefer a graduate of a four-year college with one year's
experience in the health care or long-term care field or have an
equivalent combination of education and experience.
- Requires excellent communication skills, verbal and
- Must possess a current, unencumbered license to practice as an
RN or an LPN in the state(s) where facility(s) are located.
- Must be knowledgeable of short-term practices and procedures,
as well as some familiarity with laws, regulations and guidelines
pertaining to Long Term care.
- Must possess current CPR certificate or become certified within
90 days of employment.
- Must be knowledgeable of nursing and medical practices and
- Must possess the ability to make independent decisions when
circumstances warrant such action.
- Leads and supervises to create a positive working
- Committed to improving the quality of life for those we serve
and possess the ability to work in a team environment that is
- Must have strong interpersonal skills and advanced customer
- Must possess the ability to deal tactfully with patients,
family members, hospital and facility personnel, visitors,
government agencies/personnel, and the general public.
- Must possess leadership and supervisory ability and willingness
to work harmoniously with other personnel.
- Must be able to move intermittently throughout the
- Must be able to cope with the mental and emotional stress of
- Must possess sight/ hearing senses or use prosthetics that will
enable these senses to function adequately so that the requirements
of this position can be fully met.
- Must be in good general health and demonstrate emotional
- Must be able to relate well and work with the ill, disabled,
elderly, emotionally upset and at times hostile people within the
- Prolonged standing/walking is required.
- May be required to lift, push, pull, and move equipment,
supplies, etc., throughout the day.
- Is subject to exposure to infectious waste, diseases,
conditions, etc., including exposure to the (HIV) AIDS and
Hepatitis B viruses.
- Work collaboratively with internal staff to share our message
of quality care and service.
- Understand and be able to communicate the Post-Acute
- Collaborate with Facility Administration in the planning,
coordination, and implementation of a marketing plan.
- Networking and communicating with physicians, hospital, case
managers, home health care agencies and other healthcare referral
sources to present facility and Alden information.
- Gather patient referrals and evaluate potential patient
admissions that contribute to Alden's overall revenue growth.
- Attend and participate in facility marketing meetings.
- Review admission referrals in preparation for receiving the
admission and ensuring that the patient is appropriate for the
program and that all programs and services will be promptly
implemented upon admission and collaborates with hospital nursing
staff as needed.
- Evaluate and assess patients in the hospital setting prior to
admission to the facility, when applicable to ensure for smooth
hand off from one healthcare setting to another.
- Educate the patients, families, or responsible parties about
the transition process into the facility and remain engaged through
the admission process and through discharge to the next level of
- Completes customer care phone calls post transition from
- Review admission data for tracking and trending post-acute
programs and their referral sources.
- Streamline the admission process by acquiring needed
information before the referral is sent to the facility.
- Learn with the hospital process for referrals and assist to
ensure a smooth transition to the facility.
- Collaborate with facility staff to review patient care goals
and strategies for discharge planning.
- Accept and support the Alden Mission, Our Promise, Customer
Service Values and Motto.
- Accepts and supports the Administrator and Transitional Care
Support Team philosophy of care.
- Assess, Plan, develop, organize, implement, evaluate, and
direct the facility in its post-acute and transitional care
programs and services to ensure quality of care is being
- Sure, that all procedures are followed in accordance with
established post-acute and transitional care processes and
- Directly collaborates with employees and instruct staff
providing education and training to promote job knowledge related
to post-acute programs and services.
- Identify problems, develop, and implement solutions with the
assistance of the Administrator and the Alden Post-Acute Support
- Collaborate with Administrative team with concerns or
complaints from patients, families, staff, outside resources.
- Performs other duties as assigned.
Keywords: Alden Estates of Naperville, Naperville , Transitional Care Nurse, Healthcare , Naperville, Illinois
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