RN Case Manager | Registered Nurse

RN Case Manager | Registered Nurse

Ivanhoe, MN $71,589 - $93,099 a year

Full Time

Job Summary

The RN Case Manager plays a vital role in promoting optimal social and emotional functioning, helping patients utilize healthcare and community services effectively to achieve their best health outcomes. This role recognizes the impact of psychosocial factors on recovery and focuses on patient-centered assessments and coordination of post-acute care services to ensure smooth transitions from hospital settings. Collaborating closely with interdisciplinary teams, patients, families, and community resources, the case manager helps reduce readmissions, lower costs, and enhance patient quality of life.

Essential Responsibilities

• Conduct discharge screenings, evaluations, and develop discharge plans, especially for patients with complex needs.
• Reassess and monitor discharge plans for changes in patient condition.
• Advocate for patients alongside support persons and healthcare teams.
• Provide interventions and emotional support to families during healthcare decision-making.
• Manage crisis interventions, adjustment to illness, and bereavement support.
• Coordinate resources such as skilled nursing facilities, home care, hospice, infusion services, long-term acute care, and durable medical equipment.
• Facilitate system integration, continuity of care, and interdisciplinary collaboration.
• Perform follow-up calls in accordance with Transitions of Care policies, assessing patient needs remotely and applying interventions.
• Offer resources before or after admission to support effective discharge planning.
• Conduct chemical dependency and mental health assessments with referrals to treatment.
• Assess and track readmissions.
• Provide Medicare Notification Letters.
• Assist with financial concerns by connecting patients to eligible programs and assistance.
• Conduct assessments and referrals related to abuse (adult, child, sexual, domestic violence).
• Evaluate Social Determinants of Health and assist patients in accessing government and social service programs.
• Provide information and facilitate execution of advance directives.
• Participate in departmental, hospital, and community meetings and initiatives as assigned.

Education and Experience

Bachelor's Degree in Nursing from an accredited institution (must begin program within one year and complete within five years if not already obtained). Broad clinical, administrative, and managerial healthcare experience.

Licensure/Certifications

Registered Nurse license from the appropriate state board.

Work Shift: 4th Shift

This position is based in a regional healthcare setting within the Midwest United States, offering a supportive and collaborative environment focused on patient-centered care.