RN Case Manager – Transitions of Care (Onsite Austin)

Central Health; United States; Remote; USD 75,000 - 110,000; Full time

Job summary

Santa Barbara Cottage Hospital is seeking an experienced Registered Nurse Case Manager - Transitions of Care to lead care coordination for patients with complex medical needs as they move across inpatient, outpatient, and community settings. This onsite role emphasizes clinical judgment, teamwork, and population health strategies to reduce readmissions.

The position requires robust experience in case management, strong communication, and a commitment to addressing social determinants of health

Qualifications

• Graduation from an accredited School of Nursing with an ADN – Required.
• Active RN license in the state of employment – Required.
• 3 years clinical nursing experience in hospital, home health or ambulatory settings – Required.
• 2 years case management experience – Required.
• 1 year experience managing populations with complex medical needs – Required.
• Basic Life Support (BLS) – Required.
• Driver's license – Required.
• Case Management Certification CCM/ACM – Preferred

Responsibilities

• Perform thorough in-person and telephonic assessments to evaluate medical, behavioral health and social needs.
• Coordinate care across medical, behavioral, and social providers to ensure continuity.
• Develop and manage individualized, culturally sensitive care plans with measurable goals.
• Lead the case management team and support community health workers during outreach.
• Facilitate timely establishment of primary care, dental, and specialty services.
• Provide disease- and medication-education to promote safe therapy and adherence.
• Navigate social determinants of health to address housing, food, transportation and more.

Skills

Clinical assessment

Care coordination

Interdisciplinary collaboration

Population health

Communication skills

Education

Associate Degree in Nursing (ADN)

Job description

Santa Barbara Cottage Hospital is seeking an experienced Registered Nurse Case Manager - Transitions of Care to lead care coordination for patients with complex medical needs as they move across inpatient, outpatient, and community settings. This onsite role emphasizes clinical judgment, teamwork, and population health strategies to reduce readmissions.

The position requires robust experience in case management, strong communication, and a commitment to addressing social determinants of health