The Registered Nurse (RN) Care Manager-Transition of Care, as an active member of the Care Management and interdisciplinary care team, provides comprehensive case management and discharge services to patients and families in the hospital setting utilizing foundational case management and discharge planning principles. The RN Care Manager engages the patient/patient representative in developing and implementing a post hospital plan that best meets their health and/or psychosocial needs. The RN Care Manager-Transition of Care serves as a resource for education of patient, families, peers, staff and physicians. The RN Care Manager works collaboratively with the interdisciplinary health care team and key stakeholders. The RN Care Manager-Transition of Care collaborates with the interdisciplinary team to ensure safe transition through the care continuum and identifies and removes barriers for delays of discharge. The RN Care Manager-Transition of Care links patients and families with post hospital services, screening/referral for post-acute levels of care utilizing established criteria and meeting local, state, and federal regulatory requirements. Establishes a professional, resource-based relationship with all concerned, demonstrating the mission, values, and vision of Catholic Health.
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Job Type
Full-time
Career Level
Mid Level
Industry
Hospitals
Education Level
Bachelor's degree
Number of Employees
5,001-10,000 employees