Discharge Planner/RN

Regional One Health; Memphis (TN); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health insurance

Retirement plan

Job summary

Regional One Health is seeking a Clinical Nurse Manager to design and coordinate comprehensive patient care across hospital and community settings. The position emphasizes holistic assessment, care planning, and collaboration with a broad network of providers.

The role requires RN licensure in Tennessee and experience in case management and quality improvement, with a preference for a master's degree in Nursing or Public Health. Strong leadership and communication skills are essential.

Qualifications

• RN licensure in TN required.
• Bachelor's Degree in Nursing required; Master's preferred.
• Progressive experience in care management and quality improvement.

Responsibilities

• Assess patients and families; develop care plans addressing medical and social barriers.
• Lead interdisciplinary case conferences and care coordination.
• Coordinate with hospitals, medical offices, and community organizations to broaden support services.
• Ensure safe discharge planning with appropriate follow-up.

Skills

Clinical nursing

Case management

Leadership

Quality improvement

Interdisciplinary collaboration

Patient advocacy

Communication

Education

Bachelor's Degree in Nursing

Master's Degree in Nursing or Public Health

Tools

Electronic Health Records (EHR)

HIPAA/compliance

Job description

Responsible for assessing the physical and psychosocial needs of patients and families and provides intervention to meet those needs utilizing personal, family, and community resources. Coordinates with clinical and social service providers across traditional and nontraditional settings including, but not limited to hospitals, primary care offices, homes, social service agencies. Coordinates with health system case managers and leads across boundaries.Key Job ResponsibilitiesEssential FunctionClinician:Designer/coordinator/integrator/evaluator of care to individuals, families, groups, communities, and identified populations of vulnerable populations.Demonstrates ability to understand rationale for care and competently deliver interventions to an increasingly complex and diverse population in multiple environments and settings.Performs and/or oversees the holistic assessment and develops a community based plan of care.Carries a caseload of complex patients.Outcomes Manager:Synthesizes data and translates into information and knowledge to evaluate and achieve optimal health outcomes.Collects data on interventions and outcomesAdvocacy:Adept at ensuring that patients, families, and communities are well-informed and included in planning care and is an informed leader for improving care.Serves as an advocate for the patient and the professional and interdisciplinary team.Educator:Utilizes appropriate teaching principles and strategies as well as current information, materials and technologies to teach clients, groups and other healthcare professionals.Creates, maintains and adjust individualized care plans for patients that address both medical and social barriers to accessing care.Works in conjunction with outreach team on intake assessments/care plan including medical needs/barrier identification of patients enrolled in the program; determine plan for care management.Promote activities related to the delivery of clinical services, including, but not limited to utilization review, quality assurance and clinical protocol development.Essential FunctionPlan and execute interdisciplinary case conferences/team meetings and clinical rounds.Forge and nurture partnership with hospitals, medical offices and local service organizations to broaden support services for patients.Implements policies and procedures to ensure that patients are discharged from the hospital with appropriate support systems to prevent re-admission.Demonstrates the knowledge and skills necessary to provide care appropriate to patient population and within clinical competency. Demonstrates knowledge of the principles of growth and development and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify the requirements of each patient, and to provide the care needed as described in departmental policies and procedures.Works collaboratively with hospital staff and other community/human services agencies to coordinate intervention activities; ensures that patients receive efficient services for problem resolution.Utilizes computer and information systems to enter, format data and generates statistics, computations, tables, charts and graphs.Maintains confidentiality of information in accordance with HIPAA/compliance policies and procedures.Completes required continuous training and education, including department specific requirements to maintain knowledge of case management and utilization review practices. Responds to problems/opportunities to improve work environment and participates in unit based performance improvement activities.Attends in-services, educational programs, conferences and other meetings as required.Supports and is involved in the organization’s Performance Improvement initiatives.QualificationsGraduate of an approved Nursing program RequiredRegistered Nurse licensure to work in the state of TN RequiredBachelor's Degree in nursing PreferredMaster's Degree in Nursing or Public Health PreferredEducation, training or experience to work with the patient population as assignment dictates. RequiredWork ExperienceMinimum 3 years experience Clinical nursing experience in an acute care hospital, ambulatory care setting and/or managed care organization RequiredProgressive experience in health care including direct patient care, educating staff and patients, problem solving at unit and organizational level. Project management experience or evidence of skills and abilities which demonstrate project management skills. Significant experience in continuous quality improvement and project management of an interdisciplinary team. RequiredExperience in designing an approach, determining resources needed to complete the project, selection of metmethodology, process evaluation and completion of work. RequiredAt least 1 year experience Case Management experience PreferredPhysical DemandsStanding - ConstantlyWalking - ConstantlySitting - RarelyLifting - RarelyCarrying - RarelyPushing - RarelyPulling - RarelyClimbing - RarelyBalancing - RarelyStooping - RarelyKneeling - RarelyCrouching - RarelyCrawling - RarelyReaching - RarelyHandling - OccasionallyGrasping - OccasionallyFeeling - RarelyTalking - ConstantlyHearing - ConstantlyRepetitive Motions - FrequentlyEye/Hand/Foot Coordination - Frequently