Capital Health is the region's leader in advanced medicine with significant investments in advanced technologies and the best physicians. Comprising its two hospitals (Capital Health Regional Medical Center in Trenton and the Capital Health Medical Center - Hopewell) and the Capital Health - Hamilton outpatient facility, Capital Health is a growing accredited healthcare organization. Capital Health has also received Magnet® status for the fourth consecutive time in recognition of its quality patient care, innovations in professional nursing practice, and nursing excellence. Only 29 organizations in the country have received Magnet status four times and five of those organizations are in New Jersey. In addition, our nursing team received special recognition for excellence in stroke and outpatient emergency care.
Assesses patients on assigned units based on policy. Assessments to include review of the treatment plan, determination of the appropriate level of care, assessment of discharge needs, and initiation of the discharge plan process. Collaborates with the social worker regarding patients' complex social and discharge needs.
Develops and implements a discharge plan proactively through collaboration with physicians, patients, families, multidisciplinary team members and other external caregivers as applicable, to facilitate a seamless transition from one level of care to another across the healthcare continuum.
Attends daily rounds on assigned unit with team members to ensure that the multidisciplinary plan of care is consistent with the patient's clinical course, continuing care needs and covered services as evidenced by documentation of care needs and interventions.
Reassesses continually the plan of care and discharge needs of the patient and collaborates with the members of the multidisciplinary team to modify the plans as needed based on the patient's changing needs as evidenced by weekly documentation in the progress notes.
Maintains a working knowledge of behavioral responses to illnesses and other areas (community resources, payer requirements) to facilitate the patient's movement along the healthcare continuum as demonstrated by participation in ongoing continued education with a minimum of 15 CEUs per year.
Maintains appropriate documentation in the medical record and in computer systems as required by policy or departmental practice.
Makes all appropriate referrals needed to implement the discharge plan, which include LTACH, post-acute facilities and home care, on a timely basis. Follows up to ensure that the services needed by patients/families are in place prior to discharge.
Identifies, develops and implements strategies to reduce length of stay and resource consumption.
Associate's degree required; BSN preferred.
Valid NJ RN license.
Three years of experience in a clinical nursing environment.
Experience in case management field, including utilization review, discharge planning, outcomes management, assessment care planning and care coordination, preferred.
Word-processing and spreadsheet skills.
Low employee expense for medical and dental insurance
403(b) Savings and Retirement Program
Easy commute from PA and major NJ routes.
Find out why our 4,000+ employees have chosen Capital Health.