Onsite Care Coordination Nurse

Humana Inc; Indiana (PA); Hybrid; USD 80,000 - 105,000; Full time

Job summary

Humana Inc in South Bend, IN is seeking an Onsite Care Coordination Nurse to support newly admitted members with face-to-face assessments and coordinated discharge planning. This hybrid role combines in-person work at Memorial Hospital with remote coordination tasks.

The ideal candidate is an Indiana-licensed RN with acute care experience, strong discharge planning skills, and proficiency in MS Office and EMR systems.

Qualifications

• Active RN license in Indiana
• 3+ years acute care nursing experience
• Experience in discharge planning or care coordination
• Proficient in MS Office and EMR systems
• Valid driver’s license and reliable vehicle

Responsibilities

• Conduct face-to-face assessments for newly admitted members at acute care facilities.
• Educate members and families on discharge planning and follow-up visits.
• Identify gaps in care and develop strategies to address discharge barriers.
• Collaborate with providers and care teams for timely, coordinated care.
• Provide education on diagnoses, medications, and preventive measures to reduce readmissions.
• Complete documentation accurately and promptly.
• Maintain infection control and patient privacy standards.

Skills

Acute care nursing

Discharge planning

Care coordination

Microsoft Office

EMR familiarity

Education

Bachelor’s degree in Nursing (BSN)

Tools

EMR systems

Microsoft Word/Excel/Outlook

Job description

Become a part of our caring community At Humana, we put the health and well-being of our members at the center of everything we do. As an Onsite Care Coordination Nurse, you will play a vital role in supporting members during critical moments in their care journey - serving as a trusted clinical partner within acute care settings. In this role, you’ll provide face-to-face assessments and lead care coordination efforts for newly admitted members, helping ensure smooth, safe, and timely transitions from hospital to home. By identifying gaps in care and collaborating with providers and care teams, you will directly contribute to improving health outcomes and reducing unnecessary readmissions. This is an opportunity for a nurse who is passionate about whole-person care, thrives in an autonomous environment, and values meaningful connections with members and colleagues. The role offers a hybrid work model, combining in-person engagement at assigned facilities with the flexibility to complete coordination and documentation remotely.

Key Responsibilities

• Conduct comprehensive, face to face assessments of newly admitted members at assigned acute care facilities to evaluate physical, psychosocial, and health needs; refer to Humana programs as appropriate.
• Support and educate members and families on discharge planning from admission through post-discharge, including facilitating follow-up visits with primary care providers.
• Identify gaps in care, safety concerns, and barriers to discharge; develop and implement strategies to address these issues.
• Collaborate with attending providers, facility case managers, and other healthcare professionals to ensure timely, coordinated care and effective discharge planning.
• Provide education on diagnoses, medications, and preventive measures to promote ongoing wellness and reduce risk of readmission.
• Complete all required documentation accurately and promptly.
• Maintain adherence to infection control, safety, and patient privacy standards at all times.

Onsite Location

This is an Onsite / Hybrid position at the (Memorial Hospital - 615 N Michigan Street) located in (South Bend, IN). The ideal candidate must live within a reasonable commute to the facility preferably no more than a 30-60 minute driving distance to the Onsite location from their home base.

Required Qualifications

• Current, unrestricted Registered Nurse (RN) license in the state of Indiana
• Must be Located within a 30-60 minute driving distance to (Memorial Hospital - 615 N Michigan Street) from your home base
• Minimum of 3 years recent acute care nursing experience (e.g., medical-surgical, critical care, heart/lung, skilled nursing, or rehabilitation)
• Experience with discharge planning or care coordination in a hospital or health plan settings
• Experience in Microsoft Office applications (Word, Outlook, Excel) and electronic medical records
• Valid driver’s license, dependable automobile, and proof of personal vehicle liability insurance

Preferred Qualifications

• Bachelor’s degree in Nursing (BSN)
• Experience in care management, health promotion, or coaching
• Previous Utilization Management Experience
• Previous health plan experience
• Bilingual (English/Spanish) preferred
• Certification in Care Management or related specialty