**Job Summary:**
We are seeking a highly skilled and compassionate Transitional Care Management Registered Nurse (RN) to join our team on a PRN (as-needed) basis. The RN will play a pivotal role in managing the transition of patients from hospital to home or other care settings, ensuring continuity of care and reducing readmission rates. The ideal candidate will have strong clinical skills, excellent communication, and a passion for improving patient outcomes.
**Key Responsibilities:**
- Coordinate and manage the transition of care for patients from the hospital to home or other care settings.
- Collaborate with healthcare providers, patients, and families to develop individualized care plans.
- Educate patients and caregivers on self-care practices, medication management, and follow-up appointments.
- Monitor and evaluate patient progress, making adjustments to care plans as necessary.
- Ensure timely follow-up with patients and primary care providers to address any issues or concerns.
- Document all patient interactions, assessments, and care plans in accordance with hospital policies and procedures.
- Participate in interdisciplinary team meetings to discuss patient progress and discharge planning.
- Serve as a resource for patients and families, providing support and guidance throughout the transition process.
- Maintain up-to-date knowledge of best practices in transitional care management.
**Qualifications:**
- Current RN license in FL or compact license that allows work in FL
- Minimum of 2 years of experience in a clinical or hospital setting, with experience in transitional care management or case management preferred.
- Strong clinical assessment and critical thinking skills.
- Excellent communication and interpersonal skills.
- Ability to work independently and as part of a multidisciplinary team from a quiet place at home.
- Strong organizational skills and attention to detail.
- Ability to manage multiple priorities in a fast-paced environment.
- Knowledge of electronic health records (EHR) systems and proficiency in documentation.
**Work Schedule:**
This is a PRN position, with hours varying based on the needs of the department on an as needed basis. Flexibility is required to accommodate patient needs.
**Compensation:**
Competitive hourly rate based on experience.
