RN Care Transition Manager: Lead Discharge & Transitions

Immanuel; Omaha (NE); On-site; USD 85,000 - 120,000; Full time

Benefits offered by this job

Health benefits

Employer paid life insurance

Paid time off - accrue from day one

401K with employer match

Wellness program

Education assistance up to $5,250/year

Volunteer time off

Job summary

Immanuel Pathways PACE is seeking a Care Transition Nurse Manager to coordinate care transitions for participants in Omaha, NE, ensuring seamless hospital to home, rehab, or long-term care transitions within the PACE model.

You will lead an interdisciplinary team, manage discharge planning, document in the EHR, and advocate for the participant's independence and quality of life while upholding privacy and compliance with program standards.

Qualifications

• Bachelor’s degree in nursing; RN license in the state of employment.
• Minimum 2 years nursing experience in hospital, acute care, long-term care, or community setting.
• At least 1 year of case management and multidisciplinary team experience.
• Experience with geriatric populations or completion of related training within six months.

Responsibilities

• Coordinate transitions of care for Immanuel Pathways PACE participants admitted to hospital, rehab, or long-term care.
• Lead discharge planning and collaborate with the IDT and contracted facilities.
• Document care coordination in the EHR per Immanuel Pathways standards.
• Monitor participant status during transitions and ensure continuity and safety.
• Maintain privacy and confidentiality of participant information and ensure compliance with plans.

Skills

Nursing

Case management

Geriatric care

Interdisciplinary teamwork

Education

Bachelor of Science in Nursing

Tools

EHR

Job description

Immanuel Pathways PACE is seeking a Care Transition Nurse Manager to coordinate care transitions for participants in Omaha, NE, ensuring seamless hospital to home, rehab, or long-term care transitions within the PACE model.

You will lead an interdisciplinary team, manage discharge planning, document in the EHR, and advocate for the participant's independence and quality of life while upholding privacy and compliance with program standards.