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

Case Manager (Registered Nurse) - Travel/Contract

Location: Melville, New York
Employment Type: Travel/Contract
Shift: Day, 8:00 AM – 4:00 PM (5 days/week, 40 hours/week)
Contract Length: 13 weeks

Job Summary

The Transitional Care Management (TCM) Registered Nurse (RN) coordinates and manages patient care transitions following discharge from inpatient facilities, emergency departments, skilled nursing facilities, or other care settings. The role focuses on reducing readmissions, improving patient outcomes, supporting quality performance measures, and ensuring timely follow-up care aligned with value-based care initiatives.

Key Responsibilities

• Conduct outreach to discharged patients within required timeframes (typically within 48 business hours of discharge).
• Complete comprehensive post-discharge assessments including:

  • Medication reconciliation
  • Review of discharge instructions
  • Identification of barriers to care
  • Evaluation of symptoms and clinical concerns
• Coordinate and schedule timely follow-up appointments with Primary Care Providers and specialists.
• Ensure completion of Transitional Care Management documentation requirements in EPIC.
• Monitor high-risk patients for complications, worsening symptoms, or readmission risk.
• Escalate clinical concerns promptly using appropriate communication tools (e.g., SBAR).
• Assess social determinants of health.
• Collaborate with physicians, advanced practice providers, nurses, social workers, care managers, and hospital liaisons 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.

Required Qualifications

• Valid Registered Nurse (RN) license in New York.
• Minimum of 1 year of case management experience, including experience within the last year.
• Associate of Science in Nursing (ASN) or Associate Degree in Nursing (ADN).

Additional Information

• This position supports a new program within the Quality Department.
• Utilizes evidence-based practices, population health strategies, and High Reliability Organization (HRO) principles.

Note: Prior travel experience is not explicitly required for this role.