Transitions of Care RN Case Manager

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Transitions of Care RN Case Manager based in United States.

This remote role supports high-risk patients during the critical 30 days following hospital discharge.
You will provide short-term, telephonic, interdisciplinary care management focused on preventing avoidable readmissions.
The role combines clinical assessment, patient education, care coordination, and advocacy.
You will build individualized care plans that address medical, psychosocial, medication, and resource-related needs.
Working closely with nurses, physicians, social workers, primary care providers, and community resources, you will help patients navigate complex care journeys.
The environment is collaborative, technology-enabled, and focused on measurable outcomes and exceptional patient experiences.
This is an opportunity to make a direct difference for vulnerable patients while helping shape innovative approaches to healthcare delivery.