Demo

Advanced Illness Management Nurse/CareTransition Coordinator

Dependable Health Services
Tucson, AZ Full Time
POSTED ON 2/6/2025
AVAILABLE BEFORE 3/7/2025
Advanced Illness Management (AIM) Nurse / Care Transition Coordinator

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Job Responsibilities

  • Be responsible for the overall clinical and financial operations of the Advanced Illness Management program by mitigating futile hospitalizations and case managing patients with complex illnesses that are high risk.
  • Implement and evaluate goals and objectives for advanced illness management that meet and promote high standards of quality clinical care.
  • Meet growth and development targets, both clinically and financially.
  • Establish and maintain standards of high-quality care and customer service in compliance with federal and state regulations and guidelines.
  • May provide skilled professional nursing care to patients abiding by your scope of practices and within regulations by the State Board of Registered Nursing and company policies.
  • Assess symptoms and needs and advise on basic treatment.
  • Provider education or support to patient’s families and caregivers.
  • Participate in advanced care planning.
  • Initiate referrals so the patients receives the right care at the right time.
  • Collaborate with Nurse Practitioner, PCP, and/or Medical Director to address patient needs.
  • Effectively and efficiently provide referrals to other service lines/ agencies on patient’s choice.

Registered Nurse Requirements

  • Excellent leadership, interpersonal, written and verbal communication skills.
  • Excellent organizational, problem solving, decision making, assertiveness, presentation and communication skills required.
  • Knowledge of seriously ill patients and their families, understanding of palliative care, and the ability to apply knowledge to the special needs of palliative care patients.
  • Meets mandatory continuing education requirements of Dependable Home Health and licensing board.
  • Compliance with accepted professional standards and practices.
  • Some travel may be required for this position.
  • RN with home health and/or hospice/palliative care strongly preferred.
  • Bachelor’s in nursing, Business Administration, or equivalent experience and knowledge in health care operations preferred.
  • Two or more years’ experience in home care or hospice (if also functioning as Clinical Nursing Supervisor for the office location). Experience could also be as a Clinical Director, Hospice Director, Director of Nursing (DON), RN Administrator, Executive Director.
  • Understanding of Medicare/Medicaid, Commercial insurance billing and reimbursement, and value-based care.
  • Strong communication skills.

Training/Equipment

  • Fluent competence in computer and smart phone navigation.
  • Working knowledge of Microsoft Outlook, Microsoft Word, MICROSOFT Excel, and Microsoft Power Point.
  • Must have and maintain reliable transportation to be used for work. Must maintain current auto insurance and a valid driver’s license.

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