RN Case Manager

The Registered Nurse (RN) Nursing Case Manager for Social Services is responsible for coordinating patient care, discharge planning, and psychosocial support services for residents in a Skilled Nursing Facility (SNF). This role works collaboratively with interdisciplinary teams to ensure residents receive appropriate medical care, social services, and support for safe transitions of care. The RN Case Manager advocates for residents, promotes quality outcomes, and ensures compliance with state and federal regulations governing long-term care facilities in Nevada.

• Coordinate and oversee individualized care plans for residents in collaboration with the interdisciplinary team.

• Monitor resident progress and adjust care plans to meet medical, psychosocial, and discharge needs.

• Serve as a liaison between residents, families, physicians, and external healthcare providers.

• Develop and implement discharge plans to ensure safe transitions to home, assisted living, or other care settings.

• Arrange for home health services, medical equipment, transportation, and community resources.

• Educate residents and families on post-discharge care requirements.

• Assess residents’ psychosocial needs including emotional, financial, and social concerns.

• Provide counseling, guidance, and resource referrals to residents and families.

• Assist residents with advance directives, guardianship issues, and care planning decisions when appropriate.

• Maintain documentation in accordance with (CMS) guidelines and Nevada State Board of Nursing regulations.

• Ensure compliance with federal and state long-term care standards.

• Participate in audits, surveys, and quality improvement initiatives.

• Participate in care conferences with physicians, therapists, social workers, and nursing staff.

• Facilitate communication among healthcare providers to ensure continuity of care.

• Advocate for resident rights and quality-of-life considerations.

• Maintain accurate, timely clinical and case management documentation.

• Track outcomes related to discharge planning, readmissions, and care coordination.

Education

• Associate or Bachelor’s degree in Nursing (BSN preferred).

Licensure

• Current and active Registered Nurse (RN) license in the State of Nevada.

Experience

• Minimum 2 years of nursing experience.

• Experience in case management, social services, discharge planning, or long-term care preferred.

• Skilled Nursing Facility (SNF) experience strongly preferred.

Skills

• Strong care coordination and discharge planning skills.

• Knowledge of Medicare, Medicaid, and long-term care regulations.

• Excellent communication and interdisciplinary collaboration abilities.

• Ability to manage multiple cases and prioritize effectively.