RN Care Manager: Care Coordination & Transitions

Karmanos Cancer Institute; Lansing (MI); On-site; USD 70,000 - 95,000; Full time

Job summary

McLaren Health Care, headquartered in Grand Blanc, Michigan, is seeking a Registered Nurse Care Manager - Case Management to coordinate patient transitions and optimize care across the continuum. This role emphasizes proactive assessment, timely discharge planning, and collaboration with physicians, social work, and other care providers.

The position requires RN licensure, a BSN (or active pursuit with plan to complete within five years), and at least three years of acute hospital care

Qualifications

• State licensure as a Registered Nurse (RN) is required.
• Bachelor’s degree in nursing or actively pursuing degree with plan to obtain within five years.
• Three years of acute hospital care experience.

Responsibilities

• Coordinate initial patient assessments within 24 hours of admission.
• Collaborate with social work and other disciplines for safe transitions of care.
• Assess patient/family needs to reduce barriers and plan discharge.
• Identify LOC orders and communicate with utilization management.
• Review DRG/LOS to support discharge planning with providers.
• Assess readmission risk and initiate interventions for transitions.
• Make referrals to social services and post-acute resources as SOP directs.
• Communicate daily with physicians, patients, families, and care team.
• Participate in interdisciplinary rounds and care management reviews.
• Document assessments, plans, interventions in EMR for discharge.
• Identify barriers early and coordinate with care team and payers.
• Report avoidable delays to leadership and adjust plans accordingly.
• Represent integrated care management on teams and performance committees.
• Ensure follow-up PCP appointments are arranged prior to discharge.
• Adhere to policies and maintain efficient operations.

Education

Bachelor’s degree in nursing

RN licensure

Job description

McLaren Health Care, headquartered in Grand Blanc, Michigan, is seeking a Registered Nurse Care Manager - Case Management to coordinate patient transitions and optimize care across the continuum. This role emphasizes proactive assessment, timely discharge planning, and collaboration with physicians, social work, and other care providers.

The position requires RN licensure, a BSN (or active pursuit with plan to complete within five years), and at least three years of acute hospital care