RN Care Manager: Discharge & Transitions Lead

Community Health Systems, Inc.; Fort Wayne (IN); On-site; USD 70,000 - 90,000; Full time

Job summary

Community Health Systems, Inc. is seeking a Care Manager - RN to coordinate discharge planning, transitions of care, and case management to ensure optimal patient outcomes. The role involves reviewing medical records for appropriateness and ensuring compliance with standards.

You will collaborate with interdisciplinary teams, develop discharge plans, and facilitate post-hospital care options while maintaining thorough documentation and adherence to policies.

Qualifications

• Associate Degree in Nursing required.
• Bachelor's Degree in Nursing preferred.
• 2-4 years of clinical nursing experience in a hospital, home health, or nursing home setting required.
• 2-4 years of care management experience preferred.

Responsibilities

• Conducts daily reviews of medical records to assess the appropriateness of admission, continued hospital stay, and utilization of diagnostic services.
• Collaborates with interdisciplinary teams to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
• Develops and implements discharge plans, coordinating post-hospital placement and social services to meet patient needs.
• Refs cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
• Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
• Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
• Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
• Provides assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
• Performs other duties as assigned.
• Maintains regular and reliable attendance.
• Complies with all policies and standards.

Skills

Care management

Discharge planning

Transitions of care

Interdisciplinary teamwork

EMR documentation

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Tools

EMR systems

Job description

Community Health Systems, Inc. is seeking a Care Manager - RN to coordinate discharge planning, transitions of care, and case management to ensure optimal patient outcomes. The role involves reviewing medical records for appropriateness and ensuring compliance with standards.

You will collaborate with interdisciplinary teams, develop discharge plans, and facilitate post-hospital care options while maintaining thorough documentation and adherence to policies.