Staff - Registered Nurse

SojouRN is seeking a Registered Nurse (RN) Intermediate Care for a nursing job in Los Angeles, California.

• Specialty: Intermediate Care
• Discipline: RN
• Duration: Ongoing
• 40 hours per week
• Shift: 8 hours, days
• Employment Type: Staff

qualifications
required
3+ years of experience in ANY of the following:

Geriatric Care

Senior Care

Geriatric/LTC

1+ years of experience in ANY of the following:

Transitional Care

Care Coordination

ALL of the following valid licenses/certifications:

Registered Nurse (RN) in California (CA)

American Heart Association Basic Life Support (AHA BLS) valid CA driver's license, personal transportation, good driving record and auto insurance preferred
PACE Experience (1+ years)
1+ years of experience in ANY of the following:
Cardiology
Wound Care
colostomy/ileostomy
IV Therapy
Bilingual in Spanish (yes) overview
As a Transitional Care RN, you will play a crucial role in coordinating and managing healthcare transitions for our PACE participants. Your expertise will help prevent complications, reduce readmissions, and improve health outcomes for older adults. If you are a dedicated and skilled RN with a passion for mission-driven work, we invite you to apply and make a lasting impact on the lives of our participants.
Key Responsibilities
Conduct thorough evaluations of participants during hospitalizations to identify risks for post-discharge complications and ensure a smooth transition
Visit participants in hospitals or skilled nursing facilities (SNFs) as needed to assess their medical and functional status
Develop and implement individualized transition care plans, including medication management, follow-up appointments, and home care needs
Work closely with the Medical Director and interdisciplinary team (IDT) to determine hospital admissions, observation stays, and SNF placements
Attend IDT meetings, hospital rounds, and SNF care conferences to align on participant discharge planning and ensure coordinated care
Arrange for appropriate post-discharge care, including medical equipment, medication delivery, and community support services
Educate participants and caregivers about medical conditions, treatment plans, medication adherence, and self-care strategies
Regularly check in with participants post-discharge via phone, telehealth, or home visits to assess progress, address concerns, and proactively intervene to prevent complications or readmissions
Identify high-risk cases, anticipate potential challenges, and implement solutions to improve health outcomes and reduce hospital utilization
Maintain accurate and up-to-date records of participant assessments, care plans, interventions, and all communication with healthcare providers and team members
Step in to support additional responsibilities as needed, ensuring our participants receive the highest quality care and our team thrives together
Schedule and Shift Details
Full-time position with regular daytime hours, Hybrid
Travel
Occasional travel may be required
Benefits:
401k with Employer match
Your choice of 6 medical plans, with premium coverage of up to 80% for employees and 75% for all dependents
Dental, vision, health savings account, flexible spending accounts, short- and long-term disability coverages
PTO starting at 20 days per year; plus 12 paid holidays per year, and 2 floating holidays per year
Generous CME/CEU budget and time off, and professional development opportunities
One-time stipend towards setting up your home office (for remote or hybrid roles)
Family friendly policies, including paid new parent leave.

SojouRN Job ID .