Discharge Planning RN: Care Coordination & Outcomes

The Nemours Foundation; Orlando (FL); On-site; USD 70,000 - 90,000; Full time

Job summary

Nemours Foundation is seeking a Case Management Registered Nurse in Orlando, FL to coordinate discharge planning for admitted patients in collaboration with the interdisciplinary care team. The CM RN focuses on patient- and family-centered care, with emphasis on timely discharges and reducing readmissions.

The role requires an RN/ASN with a Florida license, BSN preferred, and at least 3 years of nursing experience, plus AHA BLS within 30 days.

Qualifications

• RN/ASN required, BSN preferred
• Active Florida or multi-state RN license
• Professional certification in case management preferred
• Minimum of 3 years nursing experience
• AHA BLS required within 30 days of hire

Responsibilities

• Assessing new patients by gathering information, reviewing diagnoses, and analyzing medical test results for anticipation of discharge needs
• Complete and document an initial discharge planning assessment on all inpatients upon admission, in collaboration with the Social Worker, verifying demographics and insurance
• Process home health orders and case management referrals for post-acute care plans timely, including home health services, DME, home infusion therapies, and transfers
• Communicate with care team to ensure a discharge plan is confirmed with an expected discharge date and monitor progression
• Educates providers and clinical staff on resources available for a safe discharge
• Attend discharge planning rounds, weekly complex case reviews, and care conferences
• Coordinate with home care coordinator and social worker on transportation, letters of medical necessity, and regulatory forms
• Participate in medication discussions and ensure patient can obtain prescriptions

Skills

Discharge planning

Care coordination

Communication

Patient education

Team collaboration

Education

Bachelor's degree

Job description

Nemours Foundation is seeking a Case Management Registered Nurse in Orlando, FL to coordinate discharge planning for admitted patients in collaboration with the interdisciplinary care team. The CM RN focuses on patient- and family-centered care, with emphasis on timely discharges and reducing readmissions.

The role requires an RN/ASN with a Florida license, BSN preferred, and at least 3 years of nursing experience, plus AHA BLS within 30 days.