RN/LMSW: Complex & Transitional Care Manager II

74 Innovation Care Partners; United States; On-site; USD 90,000 - 120,000; Full time

Job summary

HonorHealth is seeking a Complex and Transitional Care Manager in Scottsdale, AZ. This role focuses on high-risk, medically complex patients, coordinating transitions across hospital, SNF, home health, and primary care.

You will develop individualized care plans and monitor progress, collaborating with physicians and embedded care coordinators to ensure safe, patient-centered care. Ideal candidates have 2+ years as a care manager or transitional care manager and an RN license; a Master's degree

Qualifications

• 2 years as Case/Care Manager or Transitional Care Manager required.
• 3 years Registered Nurse preferred.
• Bachelor's Nursing required; Master's preferred.

Responsibilities

• Coordinate patient transitions between hospitals, SNFs, home health, PCP and specialists.
• Conduct post-discharge follow-ups via phone or in-home visits.
• Develop and implement individualized care and transition plans with patients and care teams.
• Document assessments and care plans in the EMR accurately and timely.
• Support quality improvement in care transitions and chronic disease management.

Skills

Care Management

Transition of Care

RN

Education

Bachelor's Nursing

Master's Nursing

Job description

HonorHealth is seeking a Complex and Transitional Care Manager in Scottsdale, AZ. This role focuses on high-risk, medically complex patients, coordinating transitions across hospital, SNF, home health, and primary care.

You will develop individualized care plans and monitor progress, collaborating with physicians and embedded care coordinators to ensure safe, patient-centered care. Ideal candidates have 2+ years as a care manager or transitional care manager and an RN license; a Master's degree