Transition of Care Nurse Practitioner
Company: Portneuf Medical Center
Posted on: May 1, 2021
Who We Are
Patient focused, community oriented, conveniently located and
equipped with technology that rivals the nation’s most prestigious
healthcare systems, Portneuf Medical Center offers a comprehensive
and growing array of services delivered by caring and highly
skilled medical professionals.
Our mission statement “World Class Care, every patient,
every time” helps us focus on what truly matters: You. And our
commitment is to make sure our patients receive amazing care every
time they have contact with Portneuf Medical Center. The
physicians, nurses and volunteers who are a part of the Portneuf
family are your friends and neighbors. We're your community, your
hospital and team, working hard for you.
We are looking for a dynamic and passionate
Pre-Access Nurse Practitioner to join our
What You’ll Do
The Pre-Access Nurse Practitioner will provide support to
patients as they move from an acute hospital level of care to home,
or other post-acute level of care.Working closely with the ISU
Faculty and residents, the TOC NP initiates early contact with
patients post hospitalization, coordinates care and follows the
patients along the continuum of care to assist the patient in
avoiding unnecessary readmission to an acute
care hospital. The TOC NP will identify, track, and trend
data related to clinical resource management, readmission and
issues that impact patients and their clinical, financial and
quality outcomes.. The successful candidate will be able
- Identifies patients at high risk for readmission based on LACE
- Identifies patients with a need for early intervention
related to discharge education and transitional care, documents
education and plan of care in a tracking tool. Includes the
education of patients and families regarding components of
discharge instructions and available community resources as
- Has a key role in the clinical training of Family Medicine
Residents and NP students.
- Assists nursing staff, case managers and Home Health
Coordinator in setting appropriate discharge goals; collaborates
with patient, family and physician.
- Identifies actual and potential issues related to readmission
and collaborates with interdisciplinary team members to resolve
these issues when necessary. This includes collaboration with
physicians, residents and nurse coordinators at Health West
- Regularly reviews and analyzes external data relevant to care
management and readmission process.
- Collect detailed data on the patients followed and present data
to leadership team including the UR committee.
What We Offer
Competitive pay and benefits package
including Health/Dental/Vision/401(k) match. Generous paid time
off, holidays, extended illness bank, paid basic life insurance and
long term disability.
Portneuf Medical Center is an Equal Opportunity Employer
What You’ll Bring
- Nurse Practitioner or Advanced Practice Registered Nurse
- Minimum of 2 years clinical experience as NP or APRN,
5 years preferred
- Hospital, and/or home heatlhcare experience
required; Case Management, or management experience is
- Strong organizational and communication skills both written and
verbal. Must have the ability to function with a high degree
- Must be highly self-motivated with positive attitude,
flexibility and prioritization abilities.
- Must be able to write reports and make use of data to provide
clear goal setting for area of coverage; computer skills are
Keywords: Portneuf Medical Center, Pocatello , Transition of Care Nurse Practitioner, Other , Pocatello, Idaho
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