Registered Nurse (RN) Patient Care Coordinator | Avera at Home Referral Center

Avera Health · United States

Location: Avera McKennan Hospital Worker Type: Regular Work Shift: Primarily days with rotating weekends and holidays (United States of America) Pay Range: The pay range for this position is listed below. Actual pay rate dependent upon experience. $32.50 - $48.50 Position Highlights You Belong at Avera Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter. A Brief Overview Accountable for the coordination of the patient's clinical services between hospital setting and the home setting. Promotes, educates and coordinates services when the patient is transferred from the hospital to care transitions, home healthcare or hospice services. ​ What you will do

• Serves as home care expert and resource to referral sources and/or agency staff regarding patient care, treatments and services that can be provided in the home/hospice setting including skilled and nonskilled services or other programs.
• Provides clinical assessment and assists referral sources with identification of appropriate services in the post-acute home care setting including education regarding admission criteria.
• Obtains physician orders, face to face, for home care/hospice services prior to each patient’s admission to home care.
• Coordinates the home care/hospice plan as ordered by the physician.
• Clinical excellence and ability to proactively determine actual and potential complications in the home setting of care delivery for success of the patient.
• Documents each patient’s home care plan and coordination activities according to standards established by Avera.
• Facilitates communication between entities and assigned hospital/agency staff, identifying and reporting processes in the system where communication and/or continuity of care can be improved.
• Maintains knowledge of Federal and State regulations as well as Agency policies and procedures.

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

• PTO available day 1 for eligible hires.
• Up to 5% employer matching contribution for retirement
• Career development guided by hands-on training and mentorship