Transitions Of Care Nurse

Summary

Join Thyme Care as an Oncology Nurse - Transitions of Care and be on the frontlines serving cancer patients. You will conduct clinical assessments, monitor health changes, coordinate care transitions, and educate members and caregivers. This role requires a strong clinical focus, cultural competency, and the ability to improve service offerings through feedback. The position can be remote or hybrid in our Nashville office, focusing on member interactions and clinical tasks. Within three months, you will complete training, build strong member relationships, and master care team policies and procedures. You will also coordinate care, monitor progress, and build relationships with payers and providers.

Requirements

• Bachelor of Science Degree in Nursing
• Unrestricted Registered Nurse (RN) license
• Willingness to obtain additional state licenses as needed
• At least 5 years of nursing experience
• 3 years of oncology nursing or case management experience
• Certified Case Manager (CCM)
• OCN certification at time of hire or a commitment to obtain within 2 years of hire at Thyme Care
• Located within the lower 48 United States

Responsibilities

• Conduct clinical assessments
• Monitor for changes in health
• Coordinate care, including transitions
• Educate members and caregivers about their diagnosis and treatment over the phone
• Improve Thyme Care’s service offerings by communicating feedback from members and providers to our clinical leadership
• Assist with other administrative projects as needed
• Have completed training and are up to speed on Thyme Care systems, tools, technology, partners, and expectations
• Have built strong, trusting relationships with your members, where listening and empathy are the foundation for every interaction
• Be comfortable following Care Team policies and procedures, escalation pathways, communications best practices, and documentation standards
• Identify and prioritize a member's needs and help them remain safe in the community
• Assist members with care coordination and care management following admissions
• Coordinate discharge plans with hospital case managers and follow-up care with providers
• Monitor member progress, provide regular updates, and establish targeted support plans with the healthcare team in case conferences
• Build strong, trusting relationships with payers and providers to optimize care and prevent readmissions for our members
• Partner with non-clinical Care Team members to support the member’s social determinants of health needs, such as food resources, transportation access, and support at home
• Conducting telephonic assessments, including pain assessments and medication reconciliation
• Ensure members have access to medications and appointments, providing referrals and support as appropriate
• Perform virtual home safety evaluations and assess the need for DME/supplies
• Provide referrals to PT, OT, skilled nursing, palliative care, hospice care, etc., as appropriate
• Be available for urgent clinical escalations and clinical consult support

Preferred Qualifications

Experience with video chatting, Google Suite, Slack, electronic health records, or comfort in learning new technology

Benefits

• Remote or hybrid work option
• Pay rate of $45.67/hour
• 8:30 am-5:00 pm EST or 11:30 am-8 pm EST shift
• Compensation for up to 2 holidays per year at 1x and 1.5x hourly rates