**Overview** At CHI Health Creighton University Medical Center - Bergan Mercy our focus is patient-centered care. Our level I trauma center and academic medical center campus is designed to heal the body mind and spirit of every person in a more comfortable less stressful hospital environment. Our full range of medical services includes trauma services heart and vascular care emergency services surgery maternity cancer care and diagnostic imaging. **Responsibilities** 1. Completes and documents a discharge planning assessment on those patients identified by the designated screening process or upon request.Reassess the patient as appropriate and update the plan accordingly. 2. Facilitates the development of a multidisciplinary discharge plan engaging other relevant health team members the patient and/or patient representative and post acute care providers in accordance with the patients clinical or psychosocial needs choices and available resources. 3. Oversees and evaluates the implementation of the discharge plan. 4. Collaborates with the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence based guidelines/criteria. 5. Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon patients clinical needs. 6. Identifies risk for readmission and implements interventions to mitigate those risks for at least a 30-day period. 7. Responsible for delivery of appropriate patient notifications and related documentation 8. Responsible for patient education and advocacy. 9. Participates in performance improvement teams and programs as necessary. 10. Demonstrates behavior that aligns with the Mission and Core Values of the Organization. 11. Responsible for completing required education within established timeframes. 12. Adheres to all hospital policies standards of practice and Federal or State regulations pertaining to their practice. 13. Performs other duties as assigned including utilization review as necessary. **Qualifications** **Required** + Graduate of an accredited school of nursing. + Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of 1 year experience. + RN license in the state(s) covered is required. + BLS required within 3 months of hiring if located within hospital + Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used. **Preferred** + Bachelor's Degree in Nursing (BSN) or related healthcare field. + At least five (5) years of nursing experience. + Certified Case Manager (CCM) Accredited Case Manager (ACM-RN) or UM Certification preferred + Able to apply clinical guidelines to ensure progression of care. + Knowledge of managed care and payer environment preferred. + Must have critical thinking and problem-solving skills. + Collaborate effectively with multiple stakeholders + Professional communication skills. + Understand how utilization management and case management programs integrate. + Ability to work as a team player and assist other members of the team where needed. + Thrive in a fast paced self-directed environment. + Knowledge of CMS standards and requirements. + Proficient in prioritizing work and delegating where indicated. + Highly organized with excellent time management skills. \#CareCoordination **Pay Range** $32.70 - $48.65 /hour We are an equal opportunity/affirmative action employer.