Job Information

Providence RN - Transition Planning - Social Services in Everett, Washington


Providence is calling for a RN Transition Planning (1.0 FTE, Day Shift) to work in Social Services at Providence Regional Medical Center Everett in Everett, WA.

Plans and coordinates activities related to transition planning. Develops and implements a plan of care designed to meet the patient's 30 Day post hospitalization needs while ensuring continuity of care. Responsible for the collaboration with medical staff, Primary Care Physician, patient, family, community agencies, or facilities involved in patient's care, and the health care team by assessing, facilitating, planning and advocating for health needs on an individual basis resulting in quality, cost-effective outcomes.

In this position you will:

  • Demonstrates Mission/Values:

  • Assures individual respect for all while maintaining composure in dealing with difficult situations.

  • Demonstrates age specific patient care considerations for the population served.

  • Demonstrates application of knowledge, skills, and behaviors in the physical, motor/sensory, cognitive, psychosocial, patient and family education areas based on PRMCE age specific care competency assessment tool.

  • Recognizes and assesses individual patient and family needs or requirements for safe and appropriate discharge from the acute care setting.

  • Assessment for discharge needs is documented in patient's chart based on referrals, department policies, or patient/family requests.

  • Leads, develops and implements appropriate discharge plans for patients transitioning from an acute care facility to the next appropriate level of care or community, including home.

  • Patient records and PRMCE systems accurately reflect discharge planning activities.

  • Discharge plans include appropriate, effective and current community resources.

  • Works collaboratively with physicians, other healthcare team members, community agencies and family to develop a patient/family-focused discharge plan that identifies needed resources and linkages to achieve timely and optimal discharge.

  • Communicates orally and in writing in the chart with other team members and disciplines, and involves community agencies so as to insure that discharge needs and plans can be understood and executed by others as appropriate.

  • Chart documentation is complete and timely.

  • Provides patient, family, staff and physicians with pertinent community resource information, access and regulatory requirements.

  • Maintains up to date knowledge of community resources and regulatory requirements affecting patients in the hospital.

  • Participates in staff meetings and in departmental or hospital performance improvement activities or educational requirements to insure continued understanding of policies and procedures, to remain compliant with regulations, and to assist in Continuous Quality Improvement programs and follows established standard work.

  • Attends all scheduled staff meetings when scheduled on work day and is responsible to obtain staff meeting information if unable to attend. Incorporates information and education provided there into her/his work processes.

  • Participates in and assists in implementation of departmental and hospital wide quality improvement projects as required.

  • Completes all required on line courses and documents as required by hospital, health system or other regulatory authority.

  • Ensure continuity for patient post discharge for at least 30 days.

  • Communicates with patient/family post discharge in compliance with community standard.

  • Ability to answer patient questions satisfactorily and seek out appropriate information as indicated.

  • Ensures a safe hand off to the Clinic RN, Care Manager, or PCP, complying with community standard prior to 30 days.


Required qualifications for this position include:

  • Nursing degree/diploma required upon hire or equivalent education/experience

  • All Registered Nurses without a minimum of a Bachelor’s degree in Nursing must obtain a Bachelor’s degree in Nursing or higher within (5) years of hire:

  • Any previously agreed upon effective date for obtaining a Bachelor’s degree in nursing between individual and facility will remain in effect.

  • Any collective bargaining with specific time frames for obtaining a Bachelor’s degree in nursing will supersede the above point and will remain in effect.

  • Exceptions will be considered on a case-by-case basis at each facility by the most senior administrative nursing leader in consultation with the HR leader.

  • RNs employed prior to 2/1/13 are encouraged to obtain a Bachelor’s degree or higher degree in Nursing, but obtaining the degree will not be a condition of employment.

  • Registered Nurse in the State of Washington

  • Experience in discharge planning for medical and/or surgical patients in an inpatient or outpatient setting

Preferred qualifications for this position include:

  • Experience in an acute hospital setting doing discharge planning

  • Experience in an outpatient clinic setting providing primary or specialty care

About the ministry you will serve:

Providence Regional Medical Center Everett in Everett, WA is the state’s most award-winning hospital for medical care; having received the HealthGrades Distinguished Hospital Award for Clinical Excellence four years in a row. Our new state-of-the-art 12 story hospital tower and the implementation of an electronic medical records system will significantly enhance our patient’s experience throughout the continuum of care.

The hospital is located in Snohomish County on the Sound and close to the mountains, so outdoor activities such as snow skiing, kayaking, and golfing are at your doorstep. The communities in Snohomish have all the comforts and appeal of small towns, with historical districts, beautiful homes, interesting boutiques, and unique restaurants, yet the city life of Seattle and Bellevue are just 30 minutes south, while the cosmopolitan city of Vancouver, BC lies only 2 hours north.

We offer comprehensive, best-in-class benefits to our caregivers. For more information, visit

Our Mission

As expressions of God’s healing love, witnessed through the ministry of Jesus, we are steadfast in serving all, especially those who are poor and vulnerable.

About Us

Providence is a comprehensive not-for-profit network of hospitals, care centers, health plans, physicians, clinics, home health care and services continuing a more than 100-year tradition of serving the poor and vulnerable. Providence is proud to be an Equal Opportunity Employer. Providence does not discriminate on the basis of race, color, gender, disability, veteran, military status, religion, age, creed, national origin, sexual identity or expression, sexual orientation, marital status, genetic information, or any other basis prohibited by local, state, or federal law.

Schedule: Full-time

Shift: Day

Job Category: Case Management

Location: Washington-Everett

Req ID: 343371