Clinical Transitions Nurse Navigator

Carle-Health; Peoria (IL); On-site; USD 48,000 - 80,000; Full time

Job summary

Carle Health in Peoria, IL seeks an experienced RN Case Manager to oversee clinical and financial outcomes during hospitalization, ensuring proactive assessments and timely discharge planning. The role emphasizes collaboration with physicians, case managers, social workers, and care teams to determine the next level of care, coordinate transitions, and monitor progress toward patient goals.

We offer a comprehensive benefits package and opportunities to impact care across Carle Health's network;

Qualifications

• Active RN license in Illinois (IDFPR)
• Bachelor's degree required.
• Experience in case management and discharge planning preferred.

Responsibilities

• Act as a liaison with patient/family and physician to determine next level of care.
• Coordinate transition from inpatient to post-hospital care with physicians and referrals.
• Document plan of care and utilization issues in clinical records and care documents.
• Evaluate plan of care and collaborate to reduce readmission risk and length of stay.
• Investigate post-hospital coverage needs and present options to patient/family.
• Participate in multidisciplinary rounds and coordinate referrals to internal teams.
• Perform case management activities: assessment, coordination, planning, monitoring, implementation, evaluation.
• Interact with clients, caregivers and families to plan care and education.
• Oversee acute setting care plan to ensure post-hospital needs are met.
• Assist with patient discharge planning and transitions.

Skills

Case management

Discharge planning

Interdisciplinary collaboration

Assessment skills

Education

Bachelor's Degree

Licensed Registered Nurse (RN) in Illinois

Job description

Carle Health in Peoria, IL seeks an experienced RN Case Manager to oversee clinical and financial outcomes during hospitalization, ensuring proactive assessments and timely discharge planning. The role emphasizes collaboration with physicians, case managers, social workers, and care teams to determine the next level of care, coordinate transitions, and monitor progress toward patient goals.

We offer a comprehensive benefits package and opportunities to impact care across Carle Health's network;