In collaboration with the patient/family, social workers, physicians, interdisciplinary team, and payer representative, the Care Manager-RN ensures patient progression through the continuum of care in an efficient and cost effective manner. Identifies, initiates and manages optimal care coordination and discharge planning to develop patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety and length of stay management. Provides support and expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs. Monitors the provision of cost effective care to ensure care is given in the most clinically appropriate setting. Facilitates compliance with regulatory requirements and organizational performance standards, including demonstration of core competencies.