Transitional Care Management RN Case Manager
Melville, New York
Catholic Health Corporate

Transitional Care Management Registered Nurse

Overview

• Travel/contract RN role in Melville, New York
• Day shift: 8:00–16:00, 5x8 hours
• Occasional weekends
• Supports a new program in the Quality Department

Required Qualifications

• Valid RN license in New York
• Bachelor of Science in Nursing
• Case Management experience within the last year
• 1 year of Case Management experience
• BLS - Basic Life Support issued by American Heart Association

Preferred

• 3 years of ambulatory experience
• Epic experience

Role Summary

• Coordinates and manages patient care transitions after discharge from inpatient, emergency department, skilled nursing facility, or other care settings
• Works with providers, practice staff, patients, caregivers, and community resources to reduce readmissions, improve outcomes, support quality measures, and ensure timely follow-up care
• Conducts post-discharge outreach and assessments, including medication reconciliation, review of discharge instructions, identification of barriers to care, symptom review, and assessment of social determinants of health
• Schedules follow-up appointments with primary care providers and specialists
• Completes TCM documentation in EPIC
• Monitors high-risk patients and escalates clinical concerns using SBAR
• Collaborates with physicians, advanced practice providers, nurses, social workers, care managers, and hospital liaison
• Facilitates referrals for home care, behavioral health, palliative care, pharmacy support, or community resources
• Helps patients and caregivers understand diagnoses, medications, treatment plans, and self-management strategies

Additional Hiring Requirements

• Driver’s license or state ID with address and clear picture
• 7 years of employment history with gaps explained
• Standard 9-panel drug screen
• Background check and state exclusion screening
• Physical exam using the facility-specific form
• Fit test with Halyard Fluidshield N95 or 3M 1860 mask
• Proof of immunity or vaccination documentation for TB, measles, mumps, rubella, hepatitis B, varicella, and flu
• COVID vaccine collection is preferred if the candidate has received it