Our team members are the heart of what makes us better.
At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community.
Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
As a part of the population health team, the Transition Assistant - ACO, Licensed Practical Nurse, is responsible for assigned patient care and related administrative duties under the direct supervision of a licensed healthcare practitioner.
Responsibilities for this role include:
- Patient education and outreach, follow-up phone calls for disease management, managing patients at risk for readmissions, assisting in quality audits, and other duties as assigned.
- The inpatient TA ACO LPN will focus on increasing enrollment in the HMH Population Health Care Management Programs offered post-discharge, as well as focus on disease management and prevention of readmissions in the MSSP and attributed value-based populations.
- The IP-TA will work under the direction of the Pop Health Manager-Central, and will visit all attributed, admitted MSSP and value-based patients and will share patient information from previous touches, if any, by the Population Health Care Coordination Team.
- The IP-TA will work collaboratively with the inpatient case manager and the rest of the interdisciplinary team to ensure a safe transition from the hospital to the next level of care.
- The IP-TA will share the name of the nurse that will follow the patient once discharged, and will do a warm handoff to that nurse as needed. Population: MSSP and attributed value-based patients admitted to a Central Region HMH facility.
The hours for this position are 8am-4:30pm and it will require 1-2 days in the office, which is subject to change at any time.
The ideal candidate will have at least 3 years of LPN experience. Experience with a care coordination is strongly preferred.
