RN Case Manager: Discharge Planning & Care Transitions

SSM Health; St. Louis (MO); On-site; USD 70,000 - 100,000; Full time

Job summary

SSM Health St. Mary's Hospital - St. Louis is seeking a registered nurse to provide comprehensive case management and discharge planning coordination.

You will assess patient needs, develop and implement discharge plans, and collaborate with interdisciplinary teams to ensure timely transitions of care. The role emphasizes adherence to CoP guidelines and active participation in process improvements, with a day shift schedule and no on-call requirements.

Qualifications

• Graduate of accredited school of nursing or education equivalency for licensing.
• Three years' acute care experience.

Responsibilities

• Ensures compliance with Condition of Participation (CoP) discharge planning.
• Identifies and escalates gaps/barriers related to inpatient and observation length of stay.
• Assesses patients at high risk for readmission. Identifies root cause for readmission. Develops plan and collaborates with multidisciplinary team regarding discharge planning to next level of care.
• Participates with other members of team regarding opportunities for improvement in standard work.
• May also be responsible for: utilization management process, ED case management process, admission process, and act as a case manager liaison with post acute providers (skilled nursing facilities, rehab, home health, etc.).
• Applies the existing body of evidence-based practice and scientific knowledge in health care to nursing practice, ensuring that nursing care is delivered based on patient’s age-specific needs and clinical needs as described in the department's Scope of Service.
• As an SSM Health nurse, I will demonstrate the professional nursing standards defined in the professional practice model. Uses the ANA Code of Ethics for Nurses to guide his/her response to the current and evolving health and nursing needs of our patients and our patient populations.
• Works in a constant state of alertness and safe manner.
• Performs other duties as assigned.

Skills

Acute care experience

Education

Nursing degree or equivalent licensing

Job description

SSM Health St. Mary's Hospital - St. Louis is seeking a registered nurse to provide comprehensive case management and discharge planning coordination.

You will assess patient needs, develop and implement discharge plans, and collaborate with interdisciplinary teams to ensure timely transitions of care. The role emphasizes adherence to CoP guidelines and active participation in process improvements, with a day shift schedule and no on-call requirements.