• Transitional Care Member

    Job Locations US-OK-Norman
    Job ID
    HealthBack Norman
    Regular Full-Time
  • Overview

    Essential Duties and Responsibilities include the following. Other duties may be assigned.

     Confers with health team members, individually and in conference to exchange, discuss and evaluate patient information for planning, modifying and coordinating treatment programs.
     Participates in quality improvement activities.
     Collects, maintains, shares data for further development and measurement of outcomes.
     Provide comprehensive care to patients as they transition from inpatient facilities to home health.
     Will participate in various nursing roles as assigned.
     Collaborate with case management, patients, caregivers, physician and other health team members to facilitate effective transition.
     Work collaboratively with inpatient and outpatient healthcare teams to coordinate seamless individualized patient care.
     Establish professional and community knowledge to obtain resources to best meet patient needs.
     Participates in development of disease management strategies, measurement of patient outcomes related to hospital utilization, community outreach presentations and education.
     Participates in post-acute education to community skilled nursing facilities, physicians, patients and patient caregivers.
     Develops and maintains relationships with referral sources. Markets services of HealthBack Home Health.
     Coordinate and attend various community education events.
     Daily travel in assigned region required. Travel outside of region possible with potential overnight travel.

    *LPN License required


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