Top Reasons To Work at AdventHealth Hendersonville
Join a family of caregivers who provide whole person care; body - mind - spirit, to people living in communities accross Western North Carolina.
AdventHealth Hendersonville offers the uncommon compassion of a hometown community hospital powered by the support of a national health care system enabling it to provide services, technologies, and facilities to meet the whole health needs of our communities.
Faith based organization that extends Christ's healing ministry to every person, every time.
Co-workers who feel like family and together deliver on our Service standards of Keep Me Safe, Love Me, Make it Easy and Own IT.
As a part of the more than 1, 100 team members who make up AdventHealth Hendersonville, you will enjoy competitive salaries, exceptional benefits and opportunities for growth and leadership development.
Full Time Days, 40 hours per week, 10 hour shifts, Call requirement of 1 weekend day per month
You will be Responsible For:
Completes initial evalluation for transition of care needs on all identified patients within one calendar day of admission and documents according to policies and procedures. Interviews patient and involved care givers (as permitted by the patient) as well as a review of the current and past inpatient and outpatient medical record in the initial evaluation.
Reviews necessary patient information including labs, medications (pre and post hospital), history and physical therapy notes, ED notes, test results and progress notes.
Incorporates the patient/family care goals and preferences as much as possible into the transition of care planning and communicates these goals and preferences to the multidisciplinary team.
Incorporates clinical, social and financial factors into the transition of care plan.
Meets with patient/families to discuss realistic and appropriate discharge options and providers of post-hospital care.
Evaluates the potential for readmissions throughout the patient stay through the monitoring of each patient's readmission risk scores and coordinating readmission mitigation interventions.
Consults Social Work for specialty services related to psychosocial needs, decision making needs for patients who lack capacity, patient/family adjustment needs and psychosocially complex cases.
Develops discharge plan with appropriate contingency plans throughout the hospital stay to enable adaptation to evolving patient care needs and ensure timelly care coordination.
Ensures primary care physician identification and scheduling of follow-up PCP and specialist appointments for post-hospital follow up care.
And other duties as assigned
What You Will Need
Associates Degree in Nursing required
Registered Nurse (RN) required
Two years of medical/hospital nursing experience required
Computer proficiency with Outlook e-mail and electronic medical records preferred
Knowledge of community resources and post-acute care programs accross the continuum preferred
Knowledge of clinical and social factors that affect the patient's functional status at discharge preferred
Knowledge of CMS Conditions of Participation for Discharge Planning preferred
Conflict management and resolution skills preferred
The RN Care Manager in collaboration with the patient/family, social workers, nurses, physicians and the interdisciplinary team, ensures patient-centered care coordination and progression through the continuum of care. The RN Care Manager ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations. The RN Care Manager is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient evaluations of post-hospital needs; development of a transition of care plans and initiation of the implementation of the transitions of care plans prior to the discharge of the patient. The RN Care Manager is responsible for optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management. The RN Care Manager communicates daily with the interdisciplinary team during daily multidisciplinary rounds. Care coordination, discharge planning, transitions of care planning and understanding of medical necessity are core competencies of this role. The RN Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to timely and efficient care delivery and reimbursement. The RN Care Manager provides education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination. The RN Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations. The RN Care Manager adheres to departmental and system goals, objectives, policies and procedures and ensures quality patient care and regulatory compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
At AdventHealth, Extending the Healing Ministry of Christ is our mission. It calls us to be His hands and feet in helping people feel whole. Our story is one of hope — one that strives to heal and restore the body, mind and spirit. Our more than 80,000 skilled and compassionate caregivers in hospitals, physician practices, outpatient clinics, urgent care centers, skilled nursing facilities, home health agencies and hospice centers are committed to providing individualized, wholistic care.