Triage RN - Transitional Care Management

Overview

To be part of our organization, every employee should understand and share in the YNHHS Vision, support our Mission, and live our Values. These values - integrity, patient-centered, respect, accountability, and compassion - must guide what we do, as individuals and professionals, every day.

The Transitional Care Manager Triage RN is a member of the Enterprise Office of Population Health's Ambulatory Care Management team and is accountable for improving the health outcomes of the populations being managed. The TCM Triage Nurse provides clinical triage, post-discharge follow-up, and care coordination to support safe transitions of care and reduce avoidable Emergency Department visits and readmissions.

This role uses evidence-based guidelines and strong communication skills to assess patient needs, manage symptoms, provide education, and escalate care appropriately. The TCM Triage Nurse collaborates with providers, care management teams, and community resources to guide patients to the most appropriate level of care, address barriers to access, and ensure timely follow-up.

Responsibilities include post-hospital and post-ED outreach, medication and discharge plan review, referral coordination, EHR documentation, report generation, and adherence to quality, productivity, and patient experience standards. The role requires independent clinical judgment, flexibility in managing priorities, strict confidentiality, and a commitment to service excellence.