RN Case Manager: Care Coordination & Transitions

LeadingAge Virginia; Roanoke, Northern (VA, KY); Hybrid; USD 77,000 - 115,000; Full time

Benefits offered by this job

Medical, dental, vision

Pension plan

Paid time off

Onsite fitness

Job summary

Carilion Clinic in Roanoke is seeking a RN Case Manager for the Medical Pod. The role provides case management for admitted patients, coordinating referrals and ensuring smooth transitions across the care continuum.

Responsibilities include assessments, care coordination, interdisciplinary collaboration, and documentation to reflect patient status and plan of care. Requires RN licensure in Virginia and a Bachelor’s degree; BSN preferred.

Qualifications

• RN with current Virginia licensure
• Bachelor's degree required; BSN preferred
• Three years of clinical health care experience in patient care management preferred

Responsibilities

• Provide case management for assigned patient populations
• Coordinate referrals to post‑acute services (home health, hospice, DME)
• Promote efficient discharge planning and care transitions
• Collaborate with UR/SW teams and use InterQual to support medical necessity
• Document patient status and plan of care; communicate with families
• Participate in interdisciplinary team meetings and care coordination
• Ensure compliance with CMS discharge planning requirements

Skills

Clinical case management

Interdisciplinary collaboration

Discharge planning

Communication skills

Problem solving

Education

Bachelor's degree in Nursing

Tools

InterQual

Job description

Carilion Clinic in Roanoke is seeking a RN Case Manager for the Medical Pod. The role provides case management for admitted patients, coordinating referrals and ensuring smooth transitions across the care continuum.

Responsibilities include assessments, care coordination, interdisciplinary collaboration, and documentation to reflect patient status and plan of care. Requires RN licensure in Virginia and a Bachelor’s degree; BSN preferred.