JOB DESCRIPTION
Primary Duties and Responsibilities
The Care Manager I (RN) - Discharge Planner coordinates patients’ needs through the continuum of care which can include from pre-admission through post discharge plans. This role works in collaboration with the physicians, nurses, clinical staff, and community agencies to identify and arrange for appropriate care.
The Care Manager I (RN)is responsible for coordinating patient care across the continuum to ensure safe, timely, and appropriate dischargeplanning. The discharge planner collaborates closely with physicians, nursing staff, and interdisciplinary teams to assess patient needs, manage utilization, and optimize clinical outcomes. They facilitate transitions of care and identify barriers to discharge while promoting efficient use of healthcare resources. Ideal candidates demonstrate strong clinical judgement, communication skills, and the ability to work independently in a fast-paced hospital environment.
Reviews clinician assessments and patients’ financial, family and psychosocial support to develop comprehensive care and/or discharge plans. May focus more heavily on a specific aspect of Care Management like discharge planning, utilization review, and/or providing psychosocial support.
May review records to assess for appropriate admission status, level of care, payer source, and UR contracts to validate billing. May provide psychodynamic intervention and crisis counseling to support patients and families. Educates patients and families on their healthcare options and connects them with resources.
Documents pertinent patient issues, contacts and plans on the medical records. Is a mandated reporter for elder, child, and spousal abuse. The Community Care role specifically provides Care Management support to high-risk, homeless and mental health population. The ED Care Manager role also provides care managment support / collaboration when consulted for geriatric patients 65+ to address the unique needs of older adults, which may include physical, emotional, financial, and social well-being.
Performs other duties as assigned. This position requires weekend availability.
JOB QUALIFICATIONS
Education and Experience
Fulfills mandatory stroke education requirements per certification agency
Preferred skills and experience:
- Recent acute care hospital experience, preferably in case management, discharge planning.
- Experience coordinating complex discharges, including SNF, ARU, LTACH, and home health services
- Excellent interdisciplinary collaboration and communication skills
- Strong critical thinking and problem-solving abilities.
