Clinical Transitions Specialist RN - Case Management

Job Description

Job Description

Join Our Team as a Case Manager!

Are you ready to make a meaningful impact in the lives of patients during their most critical moments? At Carle Health , we are seeking a dedicated Case Manager to oversee, coordinate, and manage the functional and financial outcomes for patients experiencing acute illness requiring hospitalization. Your role will be pivotal in ensuring that patients receive proactive assessments, ongoing evaluations, and effective discharge planning, facilitating a smooth transition from hospital to home.

Your Responsibilities

As a Case Manager, you will :

• Act as a liaison between patients, families, and physicians to determine the next level of care and manage length of stay (LOS).
• Coordinate transitions from inpatient care to post-hospital care, collaborating with a variety of healthcare professionals.
• Document plans of care and utilization issues accurately in case management software and multidisciplinary documents.
• Evaluate the effectiveness of care plans and work with physicians to ensure progress toward desired patient outcomes.
• Investigate coverage for post-hospital needs and present options to patients and families.
• Participate in multidisciplinary rounds and initiate timely referrals to internal healthcare team members.
• Conduct case reviews and presentations to educate peers on unique cases and scope of practice issues.
• Assess patients for post-discharge needs and risks for readmission, navigating strategies to reduce these risks.
• Arrange necessary services such as DME, Home Care, and coordinate with social work for Hospice and ECF placements.

What We’re Looking For

To thrive in this role, you should have :

Working Conditions

At Carle Health, we believe in creating a supportive and inclusive environment where you can thrive. You will be part of a dynamic team dedicated to providing exceptional care to our patients.

Why Choose Carle Health?

When you join us, you’ll enjoy :

About Us

Find it here. Discover the job, the career, and the purpose you were meant for at Carle Health. Based in Urbana, IL, we are proud to hold Magnet® designations, the nation’s highest honor for nursing care. Join us in making a difference in the communities we serve.

We are an Equal Opportunity Employer and celebrate diversity in our workforce. Carle Health participates in E-Verify to confirm work authorization.