Under the general direction of the Director, Manager, and Lead/Supervisor Case Management RN, the Case Management (CM) RN is responsible for coordinating all aspects of discharge planning for admitted patients, in collaboration with the interdisciplinary care team, promoting patient and family centered care, with defined methods of screening, assessing, ongoing monitoring, and interventions that advance the progression of care. Process home health orders and case management referrals for post-acute care plans timely, including but not limited to, home health services, durable medical equipment, home infusion therapies, appointment scheduling and transfers to other facilities/level of care.