Registered Nurse-Transitional Case Management

Indiana University Health; Lafayette (IN); Hybrid; USD 75,000 - 95,000; Full time

Job summary

Indiana University Health in Lafayette, IN is seeking a Registered Nurse - Transitional Case Management at IU Arnett Hospital. You will coordinate care for high-risk patients after discharge, focusing on reducing readmissions and ensuring smooth transitions across care settings.

This role features a Monday–Friday day schedule with hybrid remote work (25–50% in office). The successful candidate will conduct discharge planning, patient education, and collaborate with multidisciplinary teams to

Qualifications

• ASN required.
• BSN preferred.
• Active Indiana RN license or NLC RN license.
• Graduate from a nationally accredited nursing program.
• 3–5 years of relevant experience in ambulatory care, home health, or care management.
• Phone triage experience preferred.
• BLS certification required.
• Proficiency with Microsoft Office and medical records regulations.

Responsibilities

• Coordinate care for high-risk patients post-discharge.
• Develop and implement individualized care plans.
• Identify barriers and coordinate services to prevent readmission.
• Conduct phone triage to assess needs and provide education.
• Ensure accurate discharge planning and documentation.
• Collaborate with payers for coverage approvals.
• Provide patient education and prevention programs.
• Monitor and adjust care plans to optimize outcomes.

Skills

Excellent communication

Organizational skills

Critical thinking

Phone triage (preferred)

Education

ASN required

BSN preferred

Graduate from nationally accredited nursing program

Tools

Microsoft Office

EMR systems

Job description

Overview

Job Title: Registered Nurse - Transitional Case Management

Location: IU Health Arnett

Schedule: Monday – Friday, Day Shift, Hybrid Remote (25-50% in office requirement)

Position Summary

IU Arnett Hospital is seeking a dedicated and experienced Registered Nurse - Transitional Case Management to join our team. In this pivotal role, you will coordinate care for high-risk patients post-discharge, with a focus on reducing readmissions and ensuring seamless transitions across care settings. This position offers an excellent opportunity to make a meaningful impact on patient outcomes through comprehensive discharge planning, patient education, and collaborative care management.

Key Responsibilities

• Collaborate with multidisciplinary teams to develop and implement individualized care plans for patients from pre-admission through post-discharge.
• Identify high-risk patients and implement targeted interventions to prevent readmission, ensuring smooth transitions of care.
• Conduct thorough phone triage to assess patient needs, provide education, and coordinate necessary services.
• Demonstrate strong problem-solving skills by identifying barriers, collaborating on solutions, offering alternatives, and following up to ensure resolution.
• Utilize positive reinforcement techniques by recognizing patient achievements, encouraging progress, and providing specific praise to foster engagement.
• Ensure patients are appropriately assigned to the correct level of care and receive necessary services, including post-discharge support and follow-up.
• Perform accurate, timely discharge planning and documentation, facilitating effective communication with patients, families, and healthcare team members.
• Demonstrate accountability and follow-through by providing timely reminders, ensuring the delivery of necessary materials, and maintaining ongoing patient engagement.
• Work with third-party payers to secure coverage and approvals, ensuring financial clearance for services.
• Administer patient education and prevention programs to promote health and wellness.
• Monitor, evaluate, and modify care plans as necessary to optimize patient outcomes.
• Maintain compliance with medical record documentation, healthcare regulations, and organizational policies.

Qualifications

• Requires an Associates of Nursing (ASN).
• Bachelors of Nursing (BSN) preferred.
• Requires an active Registered Nurse (RN) license in the state of Indiana or an active Nurse Licensure Compact (NLC) RN license.
• Requires that the RN has graduated from a nationally accredited nursing program.
• Minimum of 3-5 years of relevant experience, preferably in ambulatory care, home health, or care management.
• Phone triage experience is preferred.
• Requires Basic Life Support certification through the AHA.
• Other advanced life support certifications may be required per unit/department specialty according to patient care policies.
• Requires proficiency in Microsoft Office and applications.
• Requires understanding of medical record requirements, regulations and policies.

Skills and Competencies

• Excellent communication, organizational, and critical-thinking skills.
• Proven problem-solving skills, including the ability to:
  • Identify barriers
  • Collaborate on solutions
  • Offer alternatives
  • Follow up effectively
• Ability to utilize positive reinforcement strategies:
  • Recognize achievements
  • Encourage progress
  • Provide specific praise
• Demonstrated accountability and follow-through:
  • Provide reminders
  • Ensure materials are delivered
  • Maintain ongoing engagement with patients

Why Join IU Ball Memorial Hospital?

At IU Health, we are dedicated to providing outstanding patient care and fostering a collaborative, supportive work environment. This role offers a rewarding opportunity to make a meaningful difference in patients’ lives while advancing your nursing career. Join our team and be part of a community committed to excellence, innovation, and compassionate care.

We are an equal opportunity employer. IU Health does not discriminate on the basis of race, color, religion, sex, sexual orientation, age, disability, genetic information, veteran status, national origin, gender identity and/or expression, marital status or any other characteristic protected by federal, state or local law. We will ensure that individuals with disabilities are provided reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment. Please contact us to request accommodation.