Registered Nurse (RN) Patient Care Coordinator | Avera @ Home Referral Center

The Registered Nurse (RN) Patient Care Coordinator at Avera @ Home is responsible for coordinating clinical services for patients transitioning from hospital to home care or hospice. This role involves assessing patient needs, obtaining physician orders, and ensuring effective communication among healthcare teams. The RN is also accountable for maintaining compliance with regulations and documenting care plans to promote the best possible patient outcomes.

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The pay range for this position is listed below. Actual pay rate dependent upon experience.

Position Highlights

8-4:30, every 5th weekend

You Belong at Avera

Be part of a multidisciplinary team built with compassion and the goal of Moving Health Forward for you and our patients. Work where you matter.

• Serves as home care expert and resource to referral sources and/or agency staff regarding patient care, treatments and services that can be provided in the home/hospice setting including skilled and nonskilled services or other programs.
• Provides clinical assessment and assists referral sources with identification of appropriate services in the post-acute home care setting including education regarding admission criteria.
• Obtains physician orders, face to face, for home care/hospice services prior to each patient’s admission to home care.
• Coordinates the home care/hospice plan as ordered by the physician.
• Clinical excellence and ability to proactively determine actual and potential complications in the home setting of care delivery for success of the patient.
• Documents each patient’s home care plan and coordination activities according to standards established by Avera.
• Facilitates communication between entities and assigned hospital/agency staff, identifying and reporting processes in the system where communication and/or continuity of care can be improved.
• Maintains knowledge of Federal and State regulations as well as Agency policies and procedures.

• Registered Nurse (RN) - Board of Nursing An active license in the state of practice Upon Hire

• 1-3 years home health/hospice related experience

• Commitment to the daily application of Avera’s mission, vision, core values, and social principles to serve patients, their families, and our community.
• Promote Avera’s values of compassion, hospitality, and stewardship.
• Uphold Avera’s standards of Communication, Attitude, Responsiveness, and Engagement (CARE) with enthusiasm and sincerity.
• Maintain confidentiality.
• Work effectively in a team environment, coordinating work flow with other team members and ensuring a productive and efficient environment.
• Comply with safety principles, laws, regulations, and standards associated with, but not limited to, CMS, The Joint Commission, DHHS, and OSHA if applicable.

Benefits You Need & Then Some

Avera is proud to offer a wide range of benefits to qualifying part-time and full-time employees. We support you with opportunities to help live balanced, healthy lives. Benefits are designed to meet needs of today and into the future.

• PTO front-loaded for eligible hires

• Free health insurance options, for full-time single coverage on Avera High Deductible Health Plan

• Up to 5% employer matching contribution for retirement

• Career development guided by hands-on training and mentorship

Avera is an Equal Opportunity/Affirmative Action Employer Minority/Female/Disabled/Veteran/Sexual Orientation/Gender Identity. If you are an individual with a disability and would like to request an accommodation for help with your online application, please call  Show Contact Details or send an email to  Show Contact Details  .

Registered Nurse, Patient Care Coordinator, Home Health, Hospice Services, Clinical Assessment, Patient Transition, Healthcare Coordination, Health Services, Home Care, Care Management