*Applicants must meet the minimum qualifications for the position as stated in the job posting.
*Applicants must submit an additional application for each individual posting in which they are interested and qualified to perform.

Facility: OSF Saint Francis Medical Center
Peoria IL, 61637
Department: Patient Care Facilitators
Schedule: part-time
Shift: Day
Hours: M-F, Some Weekends
Hours Per Pay Period: 16
Referral Bonus:
Pay Grade: OSF 60
Job Details:


    Care Transition Coordinator (CTC) at OSF Saint Francis Medical Center and Children’s Hospital reports to the Care Transition/Outcome Lead.  The PTC supports the practice of Patient and Family Focused Care and manages interdisciplinary care on the unit.  The CTC is recognized within the unit as being proficient in the delivery of care coordination and transition. The CTC continuously promotes quality patient care by coordinating patient care conferences; assists in coordination and the development and revision of plan of care; completes a comprehensive assessment of post hospital needs in order to support quality care and meet patient needs across the continuum; serves as a role model, promotes a professional image, and encourages professional personal growth of staff.  The CTC assumes a broad level of accountability for the outcomes of care for an assignment of patients in a specific geographical area throughout their stay on a designated unit.  The CTC is responsibility to assess patient’s needs, develop a plan of care, including post hospital needs and services, and implement the plan using interdisciplinary collaboration to assist the patient toward mutually determined goals and optimal outcomes.  The CTC is in charge of the goal attainment process and is accountable for identifying and removing barriers that will prevent the patient from reaching these goals.  The CTC is responsible for assisting with collecting and analyzing data related to these individualized outcomes; ensuring an appropriate length of stay, the effective use and access to resources both in the acute care setting and community, evidence-based safe clinical practice and quality patient care.





    1.         The job incumbent is required to demonstrate the knowledge and skills necessary to provide patient care appropriate to the age of the patients served on the unit.  This requires that the incumbent demonstrates knowledge of the princi­ples of growth and devel­opment as well as the physical, emotional and psycho-social needs of the patient population served.


    2.         Work requires a professional level of knowledge of nursing practice and theory at a level that generally can be acquired by graduation from an accredited School of Nursing with a Bachelor’s degree in Nursing or completion of a Bachelor’s degree in Nursing within 3 years. The CM demonstrates knowledge in Clinical Outcome Management, Care Environment Management, and Nursing Leadership.


    3.         Minimum of 3-5 years of clinical experience in clinical specialty.  Prefer experience in Care Management. Documentation of 10 contact hours per year of continuing education, with at least 5 CEUs in Case Management.


    4.         Current State license as a Registered Nurse required.


    5.         Work may require 4 - 8 weeks orientation and on-the-job training to learn policies, procedures and work routines; to develop proficiency in providing care coordination for specific patient population. 


    6.         Work requires the interpersonal skills necessary to comfort patients, family members and/or significant others; to communicate effectively and concisely with other patient care providers; and to instruct patients, family members and/or significant others in patient plan of care and expected LOS.


    7.             Work requires analytical ability necessary to assess patients' physical, psychological and social needs, develops individual­ized patient plans of care, and evaluate patients' responses and change patient plans of care as needs.







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