RN​/Case Management

WHO WE ARE & WHAT WE DO

Tallahassee Memorial Healthcare (TMH) is a private, nonprofit community-based healthcare system that provides care to a 22‑county region in North Florida and South Georgia. We are a career destination with over 6,000 colleagues who reflect the diversity of our community. TMH is the region's healthcare leader and top provider of advanced care with a 772‑bed acute care hospital and the region's only:

• Level II Trauma Center
• Primary Stroke Center
• Level III Neonatal Intensive Care
• Pediatric Intensive Care
• The most advanced cancer, heart and vascular, orthopedic & surgery programs in the Panhandle.

Our system also includes a psychiatric hospital, multiple specialty care centers, six residency programs and more than 50 affiliated physician practices.

Your Role:

• Conducts federally mandated patient assessments based on Centers for Medicare and Medicaid Services (CMS) guidelines, including appropriate care planning, interdisciplinary communication, and Agency for Health Care Administration (AHCA) documentation preparation.
• Promotes wellness.
• Is responsible for collecting integral data and compiling/transmitting data to CMS.
• Determine patients’ needs based upon illness, diagnosis, prognosis, and social support systems.
• Contacts appropriate agencies to coordinate patient discharges into the community or long‑term care settings.
• Ensures facility compliance with applicable state and federal regulation.
• Collaborates with other members of the healthcare team.
• Discharge Planning & Placement Coordination: facilitate safe discharge placements to Inpatient Rehabilitation (IPR), Skilled Nursing Facilities (SNF), Long‑Term Care (LTC), Assisted Living Facilities (ALF), and Independent Living settings.
• Home Health & Durable Medical Equipment Coordination: arrange Home Health Care (HHC) services and Durable Medical Equipment (DME) directly from the Emergency Department.
• Transfers: assist with documentation and coordination of hospital‑to‑hospital transfers.
• Medication Support: provide patients with access to medication assistance programs and sign Letters of Agreement (LOAs) for medications when appropriate.
• Transportation Assistance: coordinate discharge transportation for patients requiring support.
• Readmission Interventions: meet with patients readmitted to the hospital within 30 days to assess contributing factors and develop prevention strategies; engage with patients who have visited the ER more than once within a six‑month period to identify barriers and connect them with appropriate resources.
• Alternative Discharge Planning: provide resources and coordinate safe discharge plans for patients presenting as social admissions, ensuring non‑medical needs are appropriately addressed.

Reports To:

• Manager for Case Management

Supervises:

• None

Required

Education:

• Associate degree in nursing.

Preferred Education:

• Bachelor’s degree in nursing.

Required Experience:

• One (1) year of relevant work experience.

Preferred Experience:

• Two (2) or more years of relevant work experience.

Required Certification/License/Registry:

• Florida RN license.

Tallahassee Memorial Health Care is an equal opportunity employer and drug‑free workplace. All employment is contingent upon successful completion of a drug screen, background check, reference verification, health assessment, and credential/license verification.