**All the benefits and perks you need for you and your family:** · Career Development · Whole Person Wellbeing Resources · Mental Health Resources and Support **Our promise to you:** Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that **together** we are even better. **Schedule:** Part-Time **Shift** :Days **Location:** 1500 SW 1 st Ave Ocala, Florida 34471 **The community you’ll be caring for:** AdventHealth Ocala · Horse Capital of the World – Home to the World Equestrian Center · Affordable cost of living · Destination for outdoor enthusiast (golf, kayaking, horseback riding, nature trails) · Vibrant downtown area with award winning establishments · Family friendly with many parks and recreations · Driving distance to Gainesville, St. Augustine, Orlando, Tampa, Sarasota · Part of the community since 1898, providing healthcare to Marion County for over 120 years · AdventHealth Hospital Ocala offers a broad spectrum of services, with programs that are nationally recognized and accredited · Spectacular springs throughout the county **The role you’ll contribute:** **The Transitional Care APRN will assist in the design and implementation, coordinate and evaluate patients targeted to reduce the number of patients who are readmitted to the hospital within 30 days of discharge and improve our length of stay. Readmitted patients will be identified using current EMR and/or ED tracking board. APRN may also be notified of high readmission risk patients to help coordinate care and prevent readmission; setting appointments with Primary Care Physician (** **PCP** **) and specialists, follow up calls as needed. APRN would also coordinate/assist care of discharged patients of skilled nursing facility (SNF), Assisted living facility (ALF), home health care (HHC), PCP, Emergency Department, Case Management, Hospitalists and specialists as needed.** **The Transitional Care ARPN will work as part of the Quality and Patient Safety team as well as an interdisciplinary team including acute care case managers, In-patient Nurse Navigators or Coordinators, physicians, nursing staff, other clinical staff, hospital leadership and home care liaisons.** **APRN will participate in committee meetings as appropriate, meetings with community partners as well as comply with data collection expectations.** **The value you’ll bring to the team:** · Engages the care team in the management of patients at risk for Readmission. · Focuses on and effectively achieves the overall reduction of readmission rates · Developing a strategy for at risk patients to successfully transition to the next level of care and decrease the risk of readmission · Daily reviews of readmissions or at-risk patients · Coordinate the transition of care with other healthcare team members: Navigators, RN, Case Management, etc. to ensure issues/concerns addressed Qualifications **The expertise and experiences you’ll need to succeed:** · Advance Practice Registered Nurse · Graduate of accredited school of Nursing · Minimum 3-5 years of recent hospital experience · APRN with active Florida License This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location. **Category:** Physician Services **Organization:** AdventHealth Ocala **Schedule:** Part-time **Shift:** 1 - Day **Req ID:** 24044258 We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.