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RN Clinical Transitions Specialist – Inpatient Case Management
Carle Health. Oversee, coordinate, and manage functional and financial outcomes for hospitalized patients .
Posted 9/25/2026full-timePeoria • Illinois • United StatesMid-LevelSenior💰 $36 - $58 per hourWebsite
About the role
Key responsibilities & impact- Oversee, coordinate, and manage functional and financial outcomes for hospitalized patients
- Conduct proactive initial assessments, ongoing evaluations, and discharge planning
- Act as liaison among patients, families, physicians, consultants, and internal/external referrals
- Coordinate transitions from inpatient care to appropriate post-hospital care
- Document plans of care and utilization issues in case management/utilization review software and multidisciplinary care documents
- Evaluate care-plan effectiveness and collaborate with physicians to support patient outcomes while managing readmission risk and length of stay
- Investigate post-hospital coverage and present options to patients, families, and providers
- Initiate pre-hospital, in-hospital, and post-hospital interventions
- Participate in multidisciplinary rounds and refer patients to healthcare team members
- Assess, plan, arrange, monitor, implement, and evaluate services; provide support and education
- Track avoidable inpatient days and conduct readmission assessments
- Assess post-discharge needs within 24–48 hours of admission and throughout the stay
- Develop post-acute strategies to reduce readmission risk
- Arrange DME, home care, outpatient infusion, hospice, ECF placement, and transportation
- Deliver or delegate regulatory letters for Medicare and observation patients
- Arrange and attend patient/family care conferences
- Conduct case review presentations for peers
Requirements
What you’ll need- Licensed Registered Professional Nurse (RN) - Illinois Department of Financial and Professional Regulation (IDFPR)
- Bachelor's Degree
- Must work a day shift schedule, Monday-Friday
- Occasional rotating holiday requirements
- Must be able to perform inpatient case management, discharge planning, utilization review, and post-hospital care coordination
Benefits
Comp & perks- Comprehensive benefits package
- Equal Opportunity Employer
- Potential for growth and life-long careers