Care Transitions & Discharge Manager

Duke University Health System; Raleigh (NC); On-site; USD 68,000 - 90,000; Full time

Benefits offered by this job

Relocation Assistance

Commitment Bonus

Job summary

Duke Raleigh Hospital in Raleigh, NC, seeks an experienced Case Manager to coordinate care transitions and discharge planning across the continuum. You will collaborate with interdisciplinary teams, educate patients and families, and ensure compliant documentation and reporting.

Requires BSN or MSW, 3+ years of relevant experience, and Case Management Certification within 3 years of hire. NC RN license for BSN candidates is required; relocation assistance may be available.

Qualifications

• BSN or MSW required.
• Minimum of 3 years of relevant experience.
• For BSN-prepared candidates: Must hold a current RN license (or compact license) in the state of North Carolina.
• Case Management Certification (ACM, CCM, or ANCC) required within 3 years of hire

Responsibilities

• Assess all assigned patients for case management needs, including discharge planning, care transitions, advocacy, consultations, and patient/family education.
• Develop, implement, and evaluate individualized discharge plans ensuring timely and appropriate transitions of care.
• Coordinate services such as Home Health, Durable Medical Equipment (DME), transportation, Substance Abuse Treatment, outpatient follow-up, SNF placement, and Acute Rehab referrals.
• Monitor daily census to ensure all patients are evaluated for case management needs.
• Maintain timely, accurate documentation of assessments, interventions, discharge arrangements, and all actions taken.
• Ensure compliance with federal, state, and local regulations, as well as organizational policies.
• Participate in Quality Assurance/Performance Improvement (QAPI) activities.
• Provide weekend, holiday, or after-hours coverage as assigned based on entity needs.

Skills

Case management

Discharge planning

Care coordination

Communication

Education

BSN or MSW

Job description

Duke Raleigh Hospital in Raleigh, NC, seeks an experienced Case Manager to coordinate care transitions and discharge planning across the continuum. You will collaborate with interdisciplinary teams, educate patients and families, and ensure compliant documentation and reporting.

Requires BSN or MSW, 3+ years of relevant experience, and Case Management Certification within 3 years of hire. NC RN license for BSN candidates is required; relocation assistance may be available.