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Registered Nurse Care Manager - Integrated Care Management

Job in Pontiac, Oakland County, Michigan, 48340, USA
Listing for: McLaren Health Care
Full Time position
Listed on 2026-01-02
Job specializations:
  • Nursing
    Healthcare Nursing, Clinical Nurse Specialist
Job Description & How to Apply Below
Position: Registered Nurse Care Manager - Integrated Care Management - (Job Number: 23004176)
Registered Nurse Care Manager - Integrated Care Management - (Job Number: )

Pay:
Competitive

Employment type:

Other

Job Description

Accountable for proactive coordination and timely transition of assigned patients to the most appropriate level of care along the continuum. Impacts key results such as achieving top decile performance in length of stay, cost-efficient resource utilization, preventing readmissions, and unnecessary emergency room visits. Works collaboratively with physicians, nursing staff, members of the multidisciplinary team (such as Home Care and PCP offices), as well as other internal and external resources.

Essential Functions and Responsibilities:

  • Performs care coordination assessments within 24 hours of admission, including assessments for readmission and transition planning.
  • Collaborates with social workers and other disciplines to ensure safe, appropriate, and timely patient transitions, considering available resources.
  • Assesses patient and family needs to reduce barriers and develop discharge plans, addressing LOS barriers to discharge.
  • Identifies unsigned level of care (LOC) orders; communicates with utilization management nurses and obtains orders from providers.
  • Reviews current DRG/LOS data within Cerner to assess discharge planning needs and identifies the primary family contact.
  • Assesses readmission risk for specific patient populations and initiates interventions to support successful transitions.
  • Coordinates discharge planning and referrals to social services, outpatient case management, DME, post-acute placement, and other agencies per SOP.
  • Acts as a liaison, collaborating daily with physicians, patients, families, nursing, and the healthcare team.
  • Participates in clinical case reviews and rounds with the interdisciplinary team.
  • Documents assessments, plans, interventions, barriers, and reassessments in the EMR to facilitate discharges and transitions, ensuring all pertinent information is transferred to post-acute agencies.
  • Identifies barriers early during patient stay and develops plans with the healthcare team, patient, and family.
  • Reports avoidable days, variances, or service delays to leadership.
  • Represents the care management department on teams, committees, and projects related to performance outcomes.
  • Ensures follow-up appointments with PCP are scheduled prior to discharge.
  • Maintains efficient operations by adhering to policies and procedures.
  • Performs other duties as required.


  • Required Qualifications:

    • State licensure as a Registered Nurse (RN)
    • Bachelor’s degree in nursing from an accredited institution or actively pursuing one, to be completed within five years of employment.
    • Minimum of three years of acute hospital care experience
    • American Case Management Certification (ACM) or eligible for certification, with ongoing continuing education
    • Basic Life Support (BLS) certification from AHA, Red Cross, or equivalent



    Preferred Qualifications:

    • Experience in utilization management, case management, critical care, or patient outcomes/quality management
    • Certification in Case Management (ACM or CCM)

    McLaren Oakland (POHRMC)
    50 N Perry St
    Pontiac, MI 48342

    About the company

    The McLaren Health Care system includes 15 hospitals, 2 HMOs, ambulatory surgery centers, diagnostics, an employed physician network, and more.

    Notice

    Talentify is an Equal Opportunity Employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.

    Reasonable accommodations are provided for qualified applicants with disabilities. Contact accessibility or call  for assistance.

    All new hires must complete Form I-9 and provide proof of identity and U.S. work eligibility. An Automated Employment Decision Tool (AEDT) will score your skills and responses. For bias audit and data-use details, visit (Use the "Apply for this Job" box below). NYC applicants may request alternative processes or accommodations at aedt or .

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