RN Case Manager: Hospital Discharge & Care Coordination

KYYBA Inc; Ann Arbor (MI); On-site; USD 75,000 - 98,000; Full time

Benefits offered by this job

401k

Term life

Voluntary life and disability coverage

Pre-paid legal plan

Identity theft protection

Medical and dependent FSA

Opportunity for advancement

Long-term assignment with potential to

Job summary

Kyyba is seeking a Case Manager RN for a 12-month assignment at Trinity Health Ann Arbor Hospital in Detroit, MI. The role requires an active Michigan RN license, 3+ years of nursing experience, and coordination with care teams to ensure safe transitions from hospital to home.

Strong discharge planning, communication, and documentation skills are essential. CCM certification or plan to obtain within 18 months is required or preferred.

Qualifications

• Minimum 3 years of clinical nursing experience.
• 1 year of managed care case management preferred.
• Experience with telephone and digital patient management preferred.

Responsibilities

• Assess patients’ clinical, functional, and social needs before discharge.
• Coordinate with hospital teams, providers, caregivers, and health plan partners.
• Identify and address discharge barriers related to medications, transportation, medical equipment, and follow-up care.
• Educate patients and caregivers on discharge instructions, medications, and post-discharge care.
• Facilitate timely clinical handoffs to the Medicare Advantage Care Management team.
• Document assessments, interventions, unresolved concerns, and follow-up plans accurately.
• Escalate patient safety concerns and participate in care coordination activities.

Skills

Clinical assessment

Communication

Care coordination

Discharge planning

Team collaboration

Education

Active Michigan RN license

CCM certification or plan to obtain within 18 months

CCP certification preferred

Job description

Kyyba is seeking a Case Manager RN for a 12-month assignment at Trinity Health Ann Arbor Hospital in Detroit, MI. The role requires an active Michigan RN license, 3+ years of nursing experience, and coordination with care teams to ensure safe transitions from hospital to home.

Strong discharge planning, communication, and documentation skills are essential. CCM certification or plan to obtain within 18 months is required or preferred.