RN Case Manager: Care Coordination & Transitions

luminishealth; Annapolis (MD); On-site; USD 48,000 - 69,000; Full time

Benefits offered by this job

Medical, Dental, and Vision Insurance

Retirement Plan with employer match

Paid Time Off

Tuition Assistance Benefits

Employee Referral Bonus Program

Paid Holidays, Disability, and Life/AD

Job summary

Luminis Health is seeking a Case Manager to coordinate patient care and ensure safe, timely transitions across the continuum in Maryland. The role involves assessing needs, planning interventions, and coordinating with a multidisciplinary team to optimize health outcomes.

Qualified candidates will have a BSN or ADN with equivalent experience and at least three years in a clinical setting. Strong documentation and knowledge of care transitions are essential.

Qualifications

• BSN or ADN with equivalent experience. BSN must be achieved within 5 years.
• Three years of experience in a clinical setting, ambulatory or post-acute.
• Care coordination experience preferred.

Responsibilities

• Identifies and prioritizes patients in need of care management using biopsychosocial factors.
• Uses motivational interviewing to promote engagement and adherence to treatment.
• Applies evidence-based guidelines to promote quality care and reduce waste; documents actions in Epic.
• Manages observation stay patients and ensures timely testing, treatment, and disposition.
• Develops and coordinates transition plans for patients moving to home with health services.
• Maintains clear documentation reflecting patient needs and family supports.
• Participates in care management projects and process improvements.
• Coordinates referrals to other health team members as needed.
• Uses risk tools to tailor interventions and prevent readmissions.
• Ensures compliance with CMS, insurers, and regulatory standards.

Skills

Care coordination

Motivational interviewing

Risk assessment

Documentation

Regulatory compliance

Education

BSN or ADN with equivalent experience

BSN within 5 years

Tools

Epic EMR

Job description

Luminis Health is seeking a Case Manager to coordinate patient care and ensure safe, timely transitions across the continuum in Maryland. The role involves assessing needs, planning interventions, and coordinating with a multidisciplinary team to optimize health outcomes.

Qualified candidates will have a BSN or ADN with equivalent experience and at least three years in a clinical setting. Strong documentation and knowledge of care transitions are essential.