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RN, Transitional Care, Full Time
Southwestern VT Medical Cntr, Transitional Care
Full Time 80 hrs per pay period

Responsibilities:
The Transitional Care Nurse (RN) partners with primary care physicians and their care team to assist with support and navigation of high risk, chronic care patients across the care continuum. The TCN will meet the patient in any setting and increase communication of critical information from one setting to another. The TCN will provide education, medication reconciliation and education, chronic disease symptom management to patients in the hospital, long term care, rehab setting and at home, collaborating with community agencies, medical home case managers, pharmacists and social workers to better meet the needs of the patient and family. The TCN will assist the patient to develop skills for improved self-management of their care and improved quality of life using shared decision making. This position will bridge the gaps from one care setting to another and improve communication and collaboration.

Requirements:
Master's Degree in Nursing or related discipline required, Clinical Nurse Specialist preferred, 3-5 years of clinical experience in an acute care setting required, some home care and long term care experience preferred, must be currently licensed as an RN in the State of Vermont.

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