Complex Transitional Care Nurse - Southern/South Central Region

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Why Work for Us? Trillium believes that empowering others begins with supporting our team. We offer our employees: A collaborative, mission-driven work environment Competitive benefits and work-from-home options for most positions Opportunities for professional growth in a diverse inclusive culture Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!

Trillium Health Resources has a career opening for a Complex Transitional Care Nurse. The core responsibility of the Complex Transitional Care Nurse is to develop personalized care planning strategies. This involves a thorough assessment of the patient’s unique situation, taking into account their medical history, social circumstances, and individual needs. The care plans are meticulously crafted with foundation in national evidence-based and informed standards, ensuring the delivery of whole person care. This evidence-based approach is crucial for achieving optimal patient outcomes and promoting long-term well-being.

Coordinate care for assigned individuals. Collaborate with internal staff to facilitate integrated care. Monitor the care plan, service delivery, and health and safety of assigned members. Complete assessments as needed. Perform clinical functions of discharge/transition planning and diversion. Provide education about all available services and natural and community supports, treatment options, diagnosis, etc.