Onsite Inpatient Case Manager - Care Transitions (RN/LPN)

MAXhealth; Sarasota (FL); On-site; USD 52,000 - 72,000; Full time

Benefits offered by this job

Hiring bonus

Job summary

MAXHealth seeks an Onsite Inpatient Case Manager to coordinate post-discharge care transitions at hospitals in Sarasota/Lakewood Ranch, FL. The role requires an RN or LPN license and 3+ years in clinical or case management to collaborate with providers and discharge planners.

Typical hours are Monday–Friday, 8:00 am–5:00 pm with some flexibility. A $500 signing bonus is offered after 30 days of employment.

Qualifications

• Active RN or LPN license required.
• Minimum 3 years of clinical or case management experience.
• Experience in care transitions, population health, or chronic disease management preferred.

Responsibilities

• Conduct face-to-face or bedside visits with attendings, patients and care team prior to discharge to assess needs, barriers, and risks.
• Develop and implement individualized transitional care plans in collaboration with providers, hospital discharge planners, and caregivers.
• Ensure timely post-discharge scheduling of follow-up appointments within 3 days as appropriate.
• Coordinate medication reconciliation and education with pharmacists or nursing staff.
• Identify and address social determinants of health impacting recovery or self-management.
• Monitor patient progress during the 30-day post-discharge period, providing outreach, coaching, and coordination as needed.
• Maintain documentation in the electronic health record (EHR) according to TCM and organizational standards.
• Track outcomes such as readmissions, ER visits, and follow-up adherence using population health tools.
• Serve as liaison between inpatient and outpatient care teams, ensuring effective communication and continuity of care.

Skills

Organizational skills

Time management

Communication

Problem solving

Professional demeanor

Education

RN license

LPN license

Tools

EMR/EHR systems

Job description

MAXHealth seeks an Onsite Inpatient Case Manager to coordinate post-discharge care transitions at hospitals in Sarasota/Lakewood Ranch, FL. The role requires an RN or LPN license and 3+ years in clinical or case management to collaborate with providers and discharge planners.

Typical hours are Monday–Friday, 8:00 am–5:00 pm with some flexibility. A $500 signing bonus is offered after 30 days of employment.