RN Care Manager - Discharge & Transitions (PRN)

Community Health Systems; Naples (CA); On-site; USD 90,000 - 130,000; Full time

Job summary

Community Health Systems seeks a Care Manager - RN to coordinate discharge planning, transitions of care, and case management across the care continuum. You will review records, collaborate with interdisciplinary teams, and identify opportunities to improve patient outcomes.

The role emphasizes compliance with federal and state standards, documentation accuracy, and effective communication with patients, families, and providers to ensure safe and timely transitions.

Qualifications

• Associate Degree in Nursing required.
• 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

• Review medical records daily to assess admission, continued hospital stay, and utilization of diagnostic services.
• Collaborate with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care.
• Develop and implement discharge plans, coordinating post-hospital placement and social services to meet patient needs.
• Refer cases to physicians or managers when patients do not meet established criteria, ensuring timely and appropriate interventions.
• Serve as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
• Facilitate interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
• Maintain accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
• Provide assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.

Skills

Case management

Discharge planning

Transitions of care

Interdisciplinary collaboration

Communication skills

Education

Associate Degree in Nursing

Bachelor's Degree in Nursing

Tools

EMR systems

Job description

Community Health Systems seeks a Care Manager - RN to coordinate discharge planning, transitions of care, and case management across the care continuum. You will review records, collaborate with interdisciplinary teams, and identify opportunities to improve patient outcomes.

The role emphasizes compliance with federal and state standards, documentation accuracy, and effective communication with patients, families, and providers to ensure safe and timely transitions.