RN Case Manager — Care Transitions Specialist

Beth Israel Deaconess Medical Center; United States; On-site; USD 95,000 - 120,000; Full time

Job summary

Mount Auburn Hospital is seeking a Case Manager RN to coordinate patient-centered care across the continuum. The role focuses on timely utilization of resources, discharge planning, and collaboration with physicians, nursing staff, social workers, and community agencies to promote optimal outcomes.

The RN will assess patient needs, develop transition plans, advocate for patients, and participate in care transitions leadership.

Qualifications

• BSN required or obtained within organizational requirements.
• Master's degree in Nursing, Healthcare Administration, Public Health, or related field preferred.
• Current RN license in the Commonwealth of Massachusetts.
• BLS certification required.
• Certification in Case Management (CCM/ACM/CMAC) preferred.

Responsibilities

• Coordinate care across the continuum to ensure timely, effective, and appropriate utilization of resources.
• Develop and implement individualized discharge and transition plans with patients and families.
• Participate in interdisciplinary rounds and care conferences.
• Coordinate services across hospital departments and external providers to remove barriers to care.
• Lead discharge planning from admission to discharge and arrange post-acute services as needed.
• Act as patient advocate while balancing clinical, regulatory, and financial considerations.
• Engage in quality improvement initiatives and ensure regulatory compliance.
• Maintain timely documentation in the electronic medical record.

Skills

Care coordination

Discharge planning

Patient advocacy

Communication

Education

BSN (required)

MSN or related field preferred

Tools

Epic EHR

Job description

Mount Auburn Hospital is seeking a Case Manager RN to coordinate patient-centered care across the continuum. The role focuses on timely utilization of resources, discharge planning, and collaboration with physicians, nursing staff, social workers, and community agencies to promote optimal outcomes.

The RN will assess patient needs, develop transition plans, advocate for patients, and participate in care transitions leadership.