Nurse (Discharge Planner)

Job description

Registered Nurse

Initiates the case management process upon admission and conducts a comprehensive inpatient assessment encompassing medical and physical health status, functional capacity, psychosocial and cognitive status, support systems, home environment, financial and insurance resources, legal needs, and immediate and long-term post-discharge care requirements, resulting in a documented, individualized discharge plan aligned with the patient's goals, clinical needs, and available resources.

Responsible for ensuring that patients receive all necessary education, equipment, resources, medication, and follow-up care for successful discharge from inpatient units.

Interacts with outside health care facilities in order to determine availability of clinical services; to facilitate appropriate transfer of care; and to participate in collaborative case management planning, discharge planning, and other care management-related activities.

Applies advanced professional registered nursing knowledge and independent clinical judgment to conduct bedside and chart-based assessments of assigned inpatients with complex, multisystem, or high-acuity health conditions, evaluating clinical status, acuity, symptom progression, treatment response, functional capacity, and psychosocial needs to develop and refine individualized nursing care plans and discharge planning strategies.

Collects, maintains, and analyzes inpatient case management program data, including true readmissions, avoidable days, length of stay, discharge disposition, and service utilization metrics, identifying trends and patterns that indicate opportunities for improvement in inpatient care coordination processes.

Worksite address

shiprock, NM, 87420, US

Who can apply

Review the original listing for work authorization, qualifications and employer requirements.