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The Registered Nurse Care Manager establishes a well-rounded care practice that includes: a patient assessment, care planning, implementation, coordination, and monitoring and ongoing routine evaluation that ensures medically and financially appropriate care. Responsibilities include: facilitating interdisciplinary team care coordination, intensive medical management of participants recently discharged from hospital and skilled nursing facilities. Additionally, this position will work closely with the IDT Social Worker and Physician to collect necessary medical and social information to ensure comprehensive decisions are made which ensure the safety and well being of participants.