Case Manager - RN Specialist - Stroke Center

Position Summary

The transitions nurse improves outcomes by reducing all cause readmissions and coordinating episodes of care among patients in a defined population or disease process. The primary focus is on the coordination and delivery of efficient, effective, compassionate, patient centered care and safe transitions across the care continuum. The transitions nurse monitors the patient care process and physiological needs; educates, documents, communicates, and collects data to evaluate and assure patient/family readiness for discharge. The transitions nurse facilitates the lateral integration of the care team, collaborating with physicians, nurses and other staff across the continuum to provide comprehensive disease management, assessment, treatment, education, and follow-up evaluation for patients; and, to communicate the plan of care in coordination with post-acute care settings.

Minimum Qualifications For Hire: Bachelors degree in nursing or other professional health care licensure. Masters preferred. Five years recent clinical experience in stroke preferred. Experience in case management or social work desired.