Care Transitions RN Case Manager

Avera Health; Sioux Falls (SD); On-site; USD 43,000 - 64,000; Full time

Benefits offered by this job

PTO from day 1

Retirement matching

Job summary

Avera at Home in Sioux Falls is seeking a Registered Nurse to manage care for patients in the Care Transitions program. You will perform patient assessments, develop care plans, and provide follow-up calls and home visits to support safe transitions.

The role emphasizes education, referrals, and care coordination across services, with a focus on improving discharge planning and patient outcomes. Must be within 1.5 hours of an Avera facility.

Qualifications

• Licensed RN with active state license.
• Experience in patient assessment and care planning is preferred.
• Strong communication and care coordination skills required.

Responsibilities

• Assess patients and develop individualized care plans.
• Coordinate follow-up calls and home visits per protocol.
• Document care in electronic medical record and ensure safe discharge planning.

Skills

RN care

Patient assessment

Care coordination

Communication

Education

Registered Nurse (RN) - Board of Nursing

Active license in state of practice

Job description

Avera at Home in Sioux Falls is seeking a Registered Nurse to manage care for patients in the Care Transitions program. You will perform patient assessments, develop care plans, and provide follow-up calls and home visits to support safe transitions.

The role emphasizes education, referrals, and care coordination across services, with a focus on improving discharge planning and patient outcomes. Must be within 1.5 hours of an Avera facility.