RN Case Manager - Home Health

Schedule: Monday–Friday | 8:00 AM – 4:30 PM Overview We are seeking a compassionate and highly organized Case Manager to join our team and play a critical role in coordinating patient care across the continuum. In this role, you will partner with patients, families, and an interdisciplinary healthcare team to ensure safe, efficient, and high-quality care from admission through discharge and beyond. This is an ideal opportunity for a clinician who thrives in a collaborative environment, enjoys problem-solving, and is passionate about advocating for patients and improving outcomes. What You’ll Do Conduct comprehensive patient assessments, including clinical, psychosocial, functional, and financial needs Develop and manage individualized care plans in collaboration with physicians, nurses, therapists, and social services Coordinate transitions of care (hospital to home, rehab, or long-term care) to ensure continuity and safety Partner with insurance providers to secure authorizations and ensure appropriate utilization of services Identify and remove barriers to discharge, including social, financial, and logistical challenges Serve as a patient advocate, ensuring needs and preferences are represented in care decisions Educate patients and families on diagnoses, treatment plans, and post-discharge care Connect patients with community resources, support services, and post-acute providers Facilitate referrals to specialized services such as housing, behavioral health, and legal resources Monitor patient progress, adjust care plans, and track outcomes and quality metrics Maintain accurate, timely documentation of assessments, interventions, and care plans Participate in interdisciplinary rounds and care conferences What You Bring Required: Active Oregon RN License or degree in Social Work, Nursing, or related healthcare field Clinical experience in acute care or home health Strong care coordination, discharge planning, or patient assessment experience Excellent communication and collaboration skills Preferred: BSN or MSN Case Management Certification (CCM or equivalent) Experience with discharge planning or case management #J-18808-Ljbffr