Care Transitions RN: Elevate Patient Flow & Discharge

Beth Israel Lahey Health; Boston (MA); On-site; USD 112,064,000 - 289,675,000; Full time

Job summary

Beth Israel Lahey Health is seeking an experienced RN Case Manager to join the Triad Model of Care Transitions. You will work with the interdisciplinary team to coordinate care progression, support safe and timely discharge, and navigate payers and services to optimize resources.

The role emphasizes collaboration with physicians, social workers, and post-acute providers to facilitate transitions, reduce delays, and improve patient outcomes.

Qualifications

• Massachusetts RN licensure required.
• 3–5 years in an acute care setting preferred.
• ACM/CCM/CMAC preferred; BLS required.

Responsibilities

• Coordinate transition plan of care with the care team to ensure safe and timely discharge.
• Collaborate with physicians, social workers, and post-acute providers to optimize patient flow.
• Identify barriers to discharge and facilitate timely interventions and resource referrals.
• Communicate plan of care clearly to patients and families and document progress.

Skills

Care coordination

Interdisciplinary teamwork

Patient advocacy

Education

RN licensure in MA

Bachelor's degree in nursing

Job description

Beth Israel Lahey Health is seeking an experienced RN Case Manager to join the Triad Model of Care Transitions. You will work with the interdisciplinary team to coordinate care progression, support safe and timely discharge, and navigate payers and services to optimize resources.

The role emphasizes collaboration with physicians, social workers, and post-acute providers to facilitate transitions, reduce delays, and improve patient outcomes.