RN Case Manager

ID: Shift: Day 5x8-Hour (08:00 - 16:00) Description: Hours: 8-4pm. Occasional position will support a new program that the Quality Department is putting in placeGeneral Summary: The Transitional Care Management (TCM) Registered Nurse (RN) is responsible for coordinating and managing patient care transitions following discharge from an inpatient facility emergency department skilled nursing facility or other care settings. The TCM RN works collaboratively with providers practice staff patients caregivers and community resources to reduce readmissions improve patient outcomes support quality performance measures and ensure timely follow-up care in alignment with value-based care TCM RN utilizes evidence-based practices population health strategies and High Reliability Organization (HRO) principles to ensure safe efficient and patient-centeredDuties/Responsibilities:Transitional Care Management Conduct outreach to discharged patients within required timeframes (typically within 48 business hours of discharge). Complete comprehensive post-discharge assessments including: oMedication reconciliation oReview of discharge instructions oIdentification of barriers to care oEvaluation of symptoms and clinical concerns Coordinate and schedule timely follow-up appointments with Primary Care Providers (PCP) and specialists. Ensure completion of TCM documentation requirements in EPIC. Monitor high-risk patients for complications worsening symptoms or readmission risk. Escalate clinical concerns to providers promptly using appropriate communication tools (SBAR). oAssessment of social determinants of health Care Coordination Collaborate with physicians advanced practice providers nurses social workers care managers and hospital liaison to ensure continuity of care. Facilitate referrals for home care behavioral health palliative care pharmacy support or community resources as needed. Assist patients and caregivers in understanding diagnoses medications treatment plans and self-management strategies. Modified Time:8/10/2026 5:00:00 AM Account Manager: Chris Stearns Account Manager Email: COVID-19 Vaccine: Required - Medical Exemptions Only Flu Vaccine: Unknown Submittals:High Job Requirements & Qualifications Previous Charge Experience : - Years of Experience : Patient Ratio Experience : Charting System Experience : Required Charting System Name : Epic Community Hospital Experience : - LTAC Experience : - Trauma Level I Experience : - Trauma Level II Experience : - Travel Experience Required : - Certifications : BLSSkills : Age Specific/Population Based Care Audits Concurrent Review Discharge Summary Familiar with CPT/HCPCS HIPAA guidelines (Health Insurance Portability and Accountability Act) Lab results blood tests/urine tests Medicare Guidelines Nurses notes Post discharge record review Post-discharge queries Retrospective Review AWV TCM Unit Details Staffing & Scheduling Scheduling Type : - Patient Ratios Days : - Patient Ratios Nights : - Patient Ratios Weekends : - Float Required : - Call Required : - Weekend Coverage : - Number of Weekend Shifts Per Contract : - Pre-Approved Time Off : one Orientation Hours : 40 Facility & Patient Care Details Patient Age Groups : - Daily Census : - Number of Visits Per Day : - Number of Rooms : - Number of Beds : - Additional Unit Information Interdisciplinary Support : - Patient Diagnoses : - Special Procedures/Unit Details : - Special Equipment : - #Tier2 Travel Compliance Prior permanent and travel work history within the Catholic Health Services of Long Island system MUST be listed in the submission profile. If it is discovered to have been left off it is cause for immediate cancellation of a signed contract. Labs: any candidate that accepts an offer needs to be in the lab within 48 hours of acceptance Interview availability for the next three business days must be disclosed at submission. Catholic only has orientation ONCE A MONTH. It is crucial travelers get started on compliance ASAP Must have 2 supervisory clinical references at time of submission or they will be redirected. Charge RN references are acceptable Prefer at least 1 travel assignment prior to coming to Good Samaritan but not required! Will consider someone with lots of experience. Local is defined as within 75 miles of the facility locals accepted at lower BR for all specialties Nursing Assistants: exception accepted at same rate NY State license must be in hand for all nursing positions and Nursys must be provided at submission. All Allied certifications must be included at submission. If a job is posted for 48 HOURS ONLY. It is not available for 3x12 s. Please ensure to pre-close your traveler prior to submission. Modules: Modules are both non-billable and billable Non-billable: time spent on modules during 16 hours of NBO Billable: time spent on modules after NBO (ex. annually) Modules are completed during orientation and annually and modules vary by specialty Modules are self-reported as well as recorded via transcripts and facility reports Submittal Details: #Tier2 Travel CompliancePrior permanent and travel work history within the Catholic Health Services of Long Island system MUST be listed in the submission profile. If it is discovered to have been left off it is cause for immediate cancellation of a signed : any candidate that accepts an offer needs to be in the lab within 48 hours of acceptanceInterview availability for the next three business days must be disclosed at only has orientation ONCE A MONTH. It is crucial travelers get started on compliance ASAPMust have 2 supervisory clinical references at time of submission or they will be redirected. Charge RN references are acceptablePreferat least 1 travel assignment prior to coming to Good Samaritan but not required! Will consider someone with lots of is defined as within 75 miles of the facility locals accepted at lower BR for all specialtiesNursing Assistants: exception accepted at same rateNY State license must be in hand for all nursing positions and Nursys must be provided at Allied certifications must be included at a job is posted for 48 HOURS ONLY. It is not available for 3x12 s. Please ensure to pre-close your traveler prior to :Modules are both non-billable and billableNon-billable: time spent on modules during 16 hours of NBOBillable: time spent on modules after NBO (ex. annually)Modules are completed during orientation and annually and modules vary by specialtyModules are self-reported as well as recorded via transcripts and facility reports Guaranteed Hours: Contract Weeks:91