Post Acute Care Program RN

Join our innovative Post Acute Care Program dedicated to providing exceptional care to patients transitioning from skilled nursing facilities (SNF) back into the community. We focus on ensuring seamless transitions medication safety and ongoing support for our patients healthcare journeys.

Type of Opportunity: Full Time FTE: 1.0 40 hours per week
Work Schedule: Monday Through Friday 8:30-5:30

Sign onandrelocation bonusesavailable for qualified candidates.

How you grow learn and thrive matters here.

• Educational and career development options including tuition and certification reimbursement scholarship opportunities
• Staff Safety (a wearable badge that allows nurses to quickly and discreetly call for help when safety is a concern)
• Shift differentials for nights and weekends
• Differentials for higher education certifications and various lead roles
• Malpractice liability insurance
• Loan forgiveness through theNew Mexico Higher Education Department
• EPIC electronic charting system

Interested in learning more about AAS or about our positions Send our recruiter an email at or send a text/call at . We look forward to hearing from you!

• Overview of Post Acute Care Program :

  The Post Acute Care Program comprises two primary components:

  • PMG SNF Provider Services:
    This program provides direct medical care for select PHP patients within skilled nursing facilities (SNF). It emphasizes collaboration with SNF leadership to adhere to established metrics and expectations ensuring a high standard of care.
  • PMG SNF Post Discharge Program:
    This program focuses on continued care for patients transitioning out of skilled nursing facilities. It includes remote monitoring weekly check-ins and collaboration with primary care physicians to facilitate community integration and follow-up for up to 90 days post-discharge. The program aims to ensure medication safety reconciliation and enhance patients understanding of their medical conditions.
• Assist the PAC-P Care Coordinator with discharge preparation and post-discharge home visits.
• Conduct medication reconciliation and follow-up visits with patients
• Follow patients to prevent escalations post discharge via remote monitoring.
• Perform acute home visits for escalations labs etc.
• Attend interdisciplinary team (IDT) and utilization review (UR) meetings as a critical team member.
• Collaborate with PAC-P interdisciplinary team SNF facilities and care teams as well as PMG primary care physicians to ensure effective patient care transitions

• Associate Degree in Nursing
• State of New Mexico or Compact State Nursing License
• BLS certification REQUIRED at time of hire
• ACLS
• PALS
• Current Drivers License & Auto Insurance
• Minimum one year acute care experience within the last 3 years required and hospice or home care experience preferred

Preferences are:

• Compassionate RN dedicated to enhancing the quality of life for geriatric patients with complex needs while valuing the importance of smooth transitions from skilled nursing facilities to home.
• Experience in acute care and home visits.
• Strong organizational skills and ability to prioritize tasks effectively.
• Excellent communication and interpersonal skills.
• Comfortable working in a flexible environment with a mix of remote and in-person patient care.
• Experience collaborating within an interdisciplinary team for post-discharge coordination.
• Ability to adapt to changes in daily work and prioritize patient needs.

Were all about well-being starting with yours.
Presbyterian employees have access to a fun engaging and unique wellness program including free on-site and community-based gyms nutrition coaching and classes mindfulness and meditation resources wellness challenges and more.

Learn more about our employee benefits.

About Presbyterian Healthcare Services

Presbyterian exists to improve the health of patients members and the communities we serve. We are a locally owned not-for-profit healthcare system comprised of nine hospitals a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908 we are the states largest private employer with nearly 13000 employees - including more than 1200 providers and nearly 3500 nurses.

Our health plan serves more than 640000 members statewide and offers Medicare Advantage Medicaid (Centennial Care) and Commercial health plans.

AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.

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