RN Case Manager - CareVio Outpatient

RN Case Manager for CareVio Outpatient. Hybrid work model with in-office 3-4 days per week and one evening weekly shift. Primary role in Transitional Care Coordination for post-acute patients, developing and evaluating comprehensive transitional care interventions to reduce readmissions and ED visits. Collaborates with multidisciplinary teams, conducts outreach through Day 30 post-discharge, and may perform onsite visits as needed. Responsibilities include coordination across inpatient facilities, discharge planning, patient/family education on disease state and self-care, assessment of social risk factors, and ensuring continuity of care through regular huddles and communication with providers and payers. Requires BSN and active RN license (or compact license) with potential to obtain non-compact licensure as needed; CCM certification or plan to obtain within 18 months. Strong critical thinking and advocacy for patients’ clinical and social needs are essential.