Transitional Care Nurse at Family Services Inc.

Town of Horseheads, New York, United States -

Full Time

Start Date

Immediate

Expiry Date

12 Mar, 26

Salary

0.0

Posted On

12 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Transitional Care, Patient Assessment, Discharge Planning, Medication Coordination, Infection Control, Community Resources, Interdisciplinary Teamwork, Communication, Relationship Building, Care Coordination, Complex Needs Management, Policy Compliance, Admission Process, Unit Treatments, Medication Administration

Industry

Description

Description Join Our Team as a Transitional Care Nurse at Bethany Village! Are you passionate about ensuring patients experience seamless, compassionate care as they move between healthcare settings? As a Transitional Care Nurse, you’ll play a key role in guiding residents through every step of their journey, from admission to discharge, while coordinating with families, healthcare teams, and community resources. Your expertise will help ensure that every transition is smooth, safe, and personalized to each resident’s needs, making a real difference in their recovery and quality of life. Position Overview: A transitional care nurse is involved when a patient/client leaves one care setting and moves to another The transitional care nurse ensures that there is a smooth transition into and out of the skilled nursing facility. Essential Duties & Responsibilities: Assist with developing discharge plans that address patients’ specific needs with the interdisciplinary team. Assessing and coordination patient’s discharge planning needs with members of their health care team, and community supports. Identifying, assessing and discharging patients with complex needs. Communicate and coordinate services between subacute care and community primary care provider. Coordinate appropriate medications for discharge. Basic Duties & Responsibilities: Has close interaction with the residents, their families, and various agencies in accordance with discharge. Maintains all updated infection control practice guidelines. Maintains all in-house infectious control requirements and establishes policy and procedures to meet the requirements and to provide reporting, including, but not limited to; influenza, pneumococcus, etc. Must maintain all updated reporting requirements for county, state and federal agencies. Endorses and complies with the vision, objectives, procedures, and policies of Bethany Village. Assist with admission orders, and the admission process Assist with unit treatments, medication pass as needed All other duties as assigned. Requirements Education Required: Licenses Practical Nurse NYS Registered Nurse License Experience Required: Knowledge of Community Services and local Agencies for discharge referral resources Ability to build relationships with community services and physicians to create a smooth transition from subacute rehab to lower level of care.

Responsibilities

The Transitional Care Nurse is responsible for ensuring smooth transitions for patients between healthcare settings, focusing on discharge planning and coordination with healthcare teams. They assist in developing personalized discharge plans and communicate with community resources to support patient needs.