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Transitional Care Registered Nurse job

Oak Street HealthCharlotte, NC
Oak Street Health jobs

Company

Skills

Benefits

Company Description

Oak Street Health is a network of primary care centers for adults on Medicare that was established in 2012. The organization operates a creative healthcare model based on quality of care over volume of services, which assumes the full financial responsibility of its patients, with the goal of restoring healthcare as it should be. In Michigan, Illinois, Pennsylvania, Ohio, Indiana, Texas, Rhode Island, North Carolina, New York, Tennessee, and Mississippi, Oak Street Health currently operates over 70 locations. Every Oakie is a mission-driven person who goes above and beyond to help their colleagues and patients. It offers perks to the employees such as paid leaves, medical insurance, and assessment program.

Job Description

Company: Oak Street Health

Title: Transitional Care Nurse

Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers that provides higher quality health and wellness care that improves outcomes, manages medical costs, and provides an unmatched experience for adults on Medicare in medically underserved communities. By providing holistic, comprehensive and integrated care right in our patient's communities, we can keep our patients healthy and then reinvest cost savings in further care for those same communities and others. Since 2013, Oak Street Health has brought its singular approach to tens of thousands of people in Illinois, Indiana, Michigan, Pennsylvania, and Ohio. At 40 locations, and with an ambitious growth trajectory, Oak Street Health is attracting and cultivating team members who embody Oak Street values and are passionate about the mission to rebuild healthcare as it should be.

For more information, visit http://www.oakstreethealth.com

Role Description

The Transitional Care Nurse is a crucial member of the interdisciplinary care team, who partner to address care gaps, manage chronic conditions and support behavioral, social and community needs. Through the management of acute and subacute transitions, s/he facilitates appropriate interventions, and collaborates with OSH and hospital teams. S/he is an assertive problem-solver, motivated to support our population who understands the value of timely discharges, low readmissions and efficient resource utilization.

Essential Functions:

* Works in partnership with [multiple] care teams to provide daily support to patients in transition away from the hospital, advocating for the patient's best interest, and intervening in the development of a discharge plan within [24 hours] of admission
* Supports care coordination of patients with complex needs, breaking down barriers to discharge, such as securing referrals or home resources
* Spends majority of time visiting hospitals and other facilities; minimal time spent in clinic
* Collaborates with hospital staff, OSH care teams and community partners to ensure high quality care provided throughout the transitions process
* Engage patients, their caregivers, and OSH providers in the hospital decision making process
* Ensure instructions, expectations and next steps are clear to the patient being discharged and their caregivers
* Provide frequent and clear updates to the in-clinic care team, ensuring a smooth handoff through home visits and discharge visits
* Develop and maintain strong working relationships with hospital staff in assigned region, [up to 5 hospitals], including planning and facilitating meetings with hospitals
* Identify and implement opportunities for efficient workflows, increased partnership and more effective patient care, particularly across OSH and hospital partners
* Report out to OSH providers and leadership on admissions, progress and opportunities for future improvement
* May conduct home visits to ensure patient transition is smooth
* May participate in care team panel meetings
*

Minimum Requirements:

* [4+] years of relevant experience, or equivalent training plus experience
* RN Licensure to practice in state
* Exceptional communication skills and customer service orientation for a wide audience including patients, caregivers and OSH and hospital providers and staff
* Innovative and independent problem-solving skills
* Comfort with accountability, and able to communicate on accomplishments and challenges
* A flexible, positive attitude
* Valid driver's license or ability to travel daily. This role will require extensive travel between facilities in the Chicagoland and Northwest Indiana area.
*

Ideal Candidates will Have:

* Nurse Case Management Credentialing (RN-BC) or be a Certified Case Manager (CCM)
* Experience with older adults
* Experience in utilization management and working with acute and subacute discharge planning ideal
* Ability to monitor and evaluate opportunities for cost effective, high quality outcomes
* Knowledge of referral coordination to community resources
* US work authorization
* Someone who embodies being "Oaky". What it means to be OAKY:
* Creating an unmatched patient experience
* Driving clinical excellence
* Taking ownership and driving for results
* Being scrappy
* Radiating positive energy
* Assuming good intentions
*



Reports to: Clinic Director / Regional Vice President

Why Oak Street?

Oak Street Health offers our coworkers advantages that can't be found in other clinical workplaces, including:

* Generous benefits, including paid vacation, health and dental benefits
* Convenient location in the City of Chicago
* Brand new, beautiful working environment
* Supportive and fun culture
* High levels of responsibility and rapid advancement
* Opportunity to be at the forefront of a revolution in healthcare

Why does Oak Street Health offer all of these benefits? Because we know what it takes to deliver the highest level of care, and our team deserves the best resources to succeed and enjoy their work. In return, we expect the best out of co-workers.

Oak Street Health is an equal opportunity employer. We embrace diversity and encourage all interested readers to apply

TASKS

  • Maintain accurate, detailed reports and records.
  • Administer medications to patients and monitor patients for reactions or side effects.
  • Record patients' medical information and vital signs.
  • Monitor, record, and report symptoms or changes in patients' conditions.

SKILLS

  • Reading ComprehensionUnderstanding written sentences and paragraphs in work related documents.
  • Active ListeningGiving full attention to what other people are saying, taking time to understand the points being made, asking questions as appropriate, and not interrupting at inappropriate times.
  • WritingCommunicating effectively in writing as appropriate for the needs of the audience.
  • SpeakingTalking to others to convey information effectively.

KNOWLEDGE

  • Customer and Personal ServiceKnowledge of principles and processes for providing customer and personal services. This includes customer needs assessment, meeting quality standards for services, and evaluation of customer satisfaction.
  • Computers and ElectronicsKnowledge of circuit boards, processors, chips, electronic equipment, and computer hardware and software, including applications and programming.
  • MathematicsKnowledge of arithmetic, algebra, geometry, calculus, statistics, and their applications.
  • BiologyKnowledge of plant and animal organisms, their tissues, cells, functions, interdependencies, and interactions with each other and the environment.
Dental Insurance
Vacation & Paid Time Off
Health Insurance

Oak Street Health

Type

Company - Private

Size

Medium

Location

Multiple locations

Industry

Healthcare

Founded

2012

CEO

Mike Pykosz

Job Filters

Company: Oak Street Health Title: Registered Nurse Bilingual Spanish Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical...Read more
Primary Care Physician, MandarinOak Street HealthHouston, TX
Title: Primary Care Physician Company Description Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides...Read more
Sales ManagerOak Street HealthSt Louis, MO
Company: Oak Street Health Title: Sales Manager (Outreach Director) Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers that provides higher quality health and wellness care that improves outcomes, manages...Read more
Nurse Practitioner Bilingual - SpanishOak Street HealthHouston, AK
Title: Nurse Practitioner Company Description Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and provides an...Read more
Outreach ExecutiveOak Street HealthRoseville, MI
Company: Oak Street Health Title: Outreach Executive Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers delivering higher quality health and wellness care that improves outcomes, manages medical costs and...Read more

Closed Job Filters

Pharmacy TechnicianOak Street HealthChicago, IL
Description Company: Oak Street Health Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers that provides higher quality health and wellness care thatRead more
Medical DirectorOak Street HealthNot Specified, MI
The Medical Director will join Oak Street Health at a critical time in the history of our company and of primary care. The opportunity for impact is large and growing, and Oak Street is leading theRead more
Pharmacy TechnicianOak Street HealthOak Brook, IL
Company: Oak Street Health Title: Pharmacy Technician Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers that provides higher quality health and wellnessRead more
Transitional Care Registered NurseOak Street HealthCharlotte, NC
Company: Oak Street Health Title: Transitional Care Nurse Oak Street Health is a rapidly growing, innovative company of community-based healthcare centers that provides higher quality health andRead more
Center Operations SupervisorOak Street HealthIndianapolis, IN
Description Company: Oak Street Health Oak Street Health is a rapidly growing company of primary care centers for adults on Medicare in medically-underserved communities where there is little to noRead more
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