May 13, 2022

Registered Nurse (RN) - Skilled Nursing Facility (SNF) Liaison - Full-Time Day

  • Prisma Health
  • Seneca, SC, USA
General Nursing

Job Description

Inspire health. Serve with compassion. Be the difference. Job Summary The RN-SNF Liaison supports the care transitions process and aids in care coordination between the hospital and the SNF as well as between the SNF and home health agency at time of discharge. Collaborates with the SNF medical team, nursing facility staff, case management and other disciplines to ensure a seamless transition between care settings. The SNF Liaison uses critical thinking, communication with the interdisciplinary team, and assessment tools to aide in scheduling visits for the NF medical team. The SNF Liaison will also work with NF staff in identifying opportunities around prevention of avoidable ED utilization and re-hospitalizations. Accountabilities Provides care transitions support. *20% Maintains knowledge of all short-term patients in the building (PMH, current episode of illness, discharge plan, support system at home, additional services needed at discharge). *10% Conducts daily record reviews on short-term patients looking for patient changes (vitals, mentation, use of prn medications, addition of new medications, decreased therapy participation, changes in PO intake, etc.). *20% Prepares for medical provider visits each day (review of EMR, conversations with facility staff, reviewing communication book, etc.). *20% Attends Medicare meetings and reviews discharge plans with SNF staff. *5% Facilitates warm hand-off with Home Health team prior to facility discharge. *5% Facilitates telehealth visits between patients/families and medical provider in the SNF. *5% Conducts root case analysis of unplanned transfers out of the facility. *5% Discerns training needs of SNF staff to meet the complexity of patient care. *5% Conducts follow-up phone calls to patients/families post-SNF discharge. *5% Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive. Minimum Requirements Associate's Degree in Nursing. BSN preferred. Three (3) years nursing experience in either acute care or post-acute care setting (SNF, IRF, Home Health or Hospice).      Required Certifications/Registrations/Licenses Licensed to practice as a Registered Nurse (RN) in South Carolina.  Other Required Skills and Experience Case Management experience is preferred. Valid driver's license, an acceptable three-year motor vehicle record as defined by the Acceptable Motor Vehicle Record (MVR) Chart, and a certificate of auto insurance. Work Shift Day (United States of America) Location Lila Doyle Nursing and Rehab Center Facility 1066 Lila Doyle Nursing & Rehabilitation Center Department 10669035 Administrative and General Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.