TRANSITIONAL CASE MANAGER- REGISTERED NURSE

NOW HIRING – RN CASE MANAGER | TRANSITIONAL CARE MANAGEMENT (TCM)

Major Long Island Healthcare System
Melville, NY
PAY: $55–$56/HR
13-Week Contract | Starting 10/26/2026
Monday–Friday | 8:00 AM–4:00 PM
40 Hours/Week
Occasional weekends

We are seeking an experienced Registered Nurse Case Manager to support an exciting new Transitional Care Management (TCM) program within the Quality Department of a major Long Island healthcare organization.

This RN will focus on coordinating patient care following discharge, reducing hospital readmissions, improving patient outcomes, and ensuring patients receive appropriate follow-up care and resources.

REQUIREMENTS:
• Active NYS RN License – REQUIRED
• Bachelor's Degree – REQUIRED
• BLS
• EPIC experience strongly preferred
• 3+ years of ambulatory experience preferred
• Strong Case Management / Care Coordination background
• Knowledge of Medicare guidelines, HIPAA, CPT/HCPCS & quality measures

KEY RESPONSIBILITIES:
• Conduct outreach to patients following hospital or facility discharge
• Complete comprehensive post-discharge assessments
• Perform medication reconciliation
• Review discharge instructions and identify barriers to care
• Assess symptoms, clinical concerns & social determinants of health
• Coordinate timely PCP and specialist follow-up appointments
• Complete TCM documentation in EPIC
• Monitor high-risk patients for complications and readmission risk
• Escalate clinical concerns to providers using SBAR
• Collaborate with physicians, APPs, nurses, social workers & care managers
• Coordinate referrals for home care, behavioral health, palliative care, pharmacy services & community resources

RELEVANT EXPERIENCE IN:
• Transitional Care Management (TCM)
• Annual Wellness Visits (AWV)
• Concurrent & retrospective review
• Post-discharge record review
• Chart/file review & audits
• Medicare guidelines
• Discharge summaries & clinical documentation

Excellent opportunity for an RN with strong ambulatory case management, care coordination, and transitional care experience!

APPLY TODAY:

gzivali@phaxis.com

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