What are the responsibilities and job description for the Transitional Care Management Nurse position at ONE Health Ohio?
Join Our Team as a Transitional Care Management Nurse!
Why Work With Us?
At One Health Ohio, we believe in fostering a positive work environment that prioritizes our team and our patients. Enjoy competitive benefits and a supportive workplace where your contributions truly matter!
Benefits Include:
- Affordable Health, Vision, Dental, and Life Insurance
- 401(K) with dollar-for-dollar matching (up to 4%)
- Generous Paid Time Off (PTO)
- Paid Holidays
Key Responsibilities:
- Provide exceptional customer service to patients and staff.
- Serve as a contact person for patient and/or caregiver within two business days of discharge from the hospital setting.
- Schedule in person visits with the patient within two weeks of their discharge.
- Help patients manage their medications and provide education and support with clinicians and outside specialists to ensure patient receives the care they need.
-
Manages and coordinates strategies that will drive quality performance in decreasing unnecessary hospital visits and hospital re-admissions, and decrease overall cost of care.
Develop, implement, and revise framework to provide high quality care in medication adherence to all populations geographically assigned to the organization.
Utilize Population Health tools and EHR to plan, organize and monitor resources for successful completion of hospital follow up.
Follow After-hours calls to ensure patients can have same day appointments.
Utilizes Population Health tools to optimize the process of data entry, retrieval, storage, analysis, accurate and timely reporting of data and program outcomes through collaboration with leadership team for quality measures.
Creates best practice workflows and process mapping for optimal delivery of care to meet measure targets.
Provides expertise in knowing our high risk patients and working with them to maintain plan of care.
Advanced ability to identify and compile data from multiple sources to produce and distribute reports to support the QI process.
- Other duties as assigned.
Ideal Candidates Will Have:
- Licensed Registered Nurse preferred; Master’s level in Informatics a plus.
- Minimum 2 years of experience in a clinical or community healthcare setting.
- Familiarity with third-party payer regulations is preferred.
Preferred/Desired Skills and Abilities:
- Uphold One Health Ohio’s core values and policies.
-
Analytical and Organized
Health IT systems and reports
Proactive approach, ability to work independently.
Possess good oral and written communication skills
Adhere to HIPPA regulations and maintain confidentiality
Able to work in a fast paced environment
Detail oriented
Ability to multi-task, meet deadlines and adapt to changing requirements
Present a positive and professional attitude
Proficient in Microsoft Office (Word, Excel, Outlook, Publisher)
Ability to identify problems and to propose feasible solutions
Outstanding inter-personal and human relations skills
Ability to maintain accurate records
Physical Requirements:
- Ability to sit for extended periods and perform tasks requiring finger dexterity.
- Communication skills using the spoken word
Ready to Make a Difference?
If you’re passionate about patient care and want to join a dedicated team that values your expertise, we’d love to hear from you! Apply today and take the next step in your career with One Health Ohio.
Equal Opportunity Employer:
We celebrate diversity and are committed to creating an inclusive environment for all employees.
NOTE: This job description is not intended to be all-inclusive. Employee may perform other related duties as negotiated to meet the ongoing needs of the organization. Employee is able to work at any OHO locations deemed necessary by OHO.
Licenses & Certifications
Required- REGISTERED NURSE LICENSE
Equal Opportunity Employer/Protected Veterans/Individuals with Disabilities
The contractor will not discharge or in any other manner discriminate against employees or applicants because they have inquired about, discussed, or disclosed their own pay or the pay of another employee or applicant. However, employees who have access to the compensation information of other employees or applicants as a part of their essential job functions cannot disclose the pay of other employees or applicants to individuals who do not otherwise have access to compensation information, unless the disclosure is (a) in response to a formal complaint or charge, (b) in furtherance of an investigation, proceeding, hearing, or action, including an investigation conducted by the employer, or (c) consistent with the contractor’s legal duty to furnish information. 41 CFR 60-1.35(c)
