RN Case Manager, Transition of Care (TOC)

Job Description: Cityblock’s Transition of Care (TOC) program helps members safely navigate their post-discharge journey from acute care and hospital settings back into the community. The TOC Registered Nurse Care Manager (RNCM) coordinates with hospital case managers to determine members’ needs and to complete discharge visits (in-home or virtual) with members and providers. The TOC RNCM will also be available for referrals to triage members’ needs and provide clinical education, with the goal of helping ensure that members do not return to the hospital. Responsibilities: Assign members and initiate outreach by contacting hospital case managers to understand each member's unique needs before engaging them in the TOC program.…