Job Description
Employment Type:
Full time
Shift:
Description:
the patient's follow up with their primary care provider and specialists.
Under the direction of the SMMG Medical Director and supervision of the Nurse Manager of Clinical Services, the RN Transitional Care Manager is responsible for providing services for a panel of identified High Risk patients with medical and/or psychosocial problems who have had an emergency room visit and/or skilled care inpatient admission. The timeframe of Transitional Care Management is from the initial ER and/or inpatient event to their return to independent or assisted living as appropriate for their level of acuity. Transitional Care Management services include non-face-to-face communication with the patient and/or caregiver, hospital case manager, home health agencies, specialist referrals, outside community and health resources and assistance with scheduling the patient's follow up with their primary care provider and specialists.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.