Rn transition coordinator

Embedded Transitional Care Manager RN

Oak Street Health takes a team-based approach to providing outstanding patient c...

Location

United States , Rockford

Salary:

66575.00 - 142576.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

An active RN license within the state of practice in good standing
Willingness to obtain cross-state licensure, as needed
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
Experience in utilization management preferred
Knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
Exceptional communication skills and customer service orientation
Innovative and independent problem solving skills
Ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required

Job Responsibility

Manage patients through transitions of care
Advocate for the patient throughout the care continuum
Identify opportunities for improved program workflows
Maintain real-time and accurate records of patient status
Adhere to CMS, state specific and NCQA compliance criteria
Evaluate patient status post-ED visit or observation stay
Triage to determine appropriate follow up care
Engage directly with inpatient physicians, case managers, medical directors, and hospitalists
Coordinate with the Utilization Management team
Conduct structured clinical assessment to identify post-discharge needs

What we offer

Paid vacation, sick time, and investment/retirement 401K match options
Health insurance, vision, and dental benefits
Affordable medical plan options
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching
Benefit solutions that address the different needs and preferences of our colleagues including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access

Fulltime

Care Transitions Coordinator RN/LPN Clinical Sales

Are you looking for a rewarding career as a care transitions coordinator? If so,...

Location

United States , Rosedale

Salary:

85000.00 - 90000.00 USD / Year

Amedisys

Expiration Date

Until further notice

Requirements

At least one year of experience in a healthcare related business development/outreach role
Current RN or LPN license, specific to the state(s) you are assigned to work
Reliable transportation, current driver's license, and liability insurance
This role will travel 50% or more within the assigned territory

Job Responsibility

Educates health care professionals, patients, and families about home care services
Develops and maintains relationships with key referral sources, such as hospitals, nursing homes and physician offices to generate leads
Coordinates patient admissions with the team, including obtaining all required documentation to complete referral to admission process
Conducts on-site visits to assess patient needs and identify barriers to care
Keeps accurate records of patient interactions and referrals
Achieves admissions, product, and payor-mix goals
Meets short and long-term target account goals
Documents the minimum expectation of sales calls daily in CRM (including pre and post call notes)
Maintains a complete, up-to-date record of targeted referral sources in territory in CRM
Attends community events to promote Amedisys

What we offer

A full benefits package with choice of affordable PPO or HSA medical plans
Paid time off
Up to $1,000 in free healthcare services paid by Amedisys yearly, when enrolled in an Amedisys HSA medical plan
Up to $500 in wellness rewards for completing activities during the year
Mental health support, including up to five free counseling sessions per year through the Amedisys Employee Assistance program
401(k) with a company match
Family support with infertility treatment coverage, adoption reimbursement, paid parental and family caregiver leave
Fleet vehicle program (restrictions apply) and mileage reimbursement

Fulltime

Embedded Transitional Care Manager

The Embedded Transitional Care Manager - RN (TCM-RN) plays a critical role in en...

Location

United States , Indianapolis

Salary:

54095.00 - 116760.00 USD / Year

CVS Health

Expiration Date

Until further notice

Requirements

An active RN license within the state of practice in good standing
willingness to obtain cross-state licensure, as needed
Certified Case Manager (CCM) or equivalent case management certification required, or willingness to obtain within 12 months of hire
2+ years’ experience in transitional nursing, discharge planning, nursing case management, or home health
experience in utilization management preferred
knowledge of Medicare/Medicaid and NCQA regulatory transitions of care criteria
exceptional communication skills and customer service orientation
innovative and independent problem-solving skills
ability to monitor and evaluate opportunities for cost-effective care options with high-quality outcomes
Spanish-speaking preferred but not required

Job Responsibility

Manage patients through transitions of care, either face to face in the facility or telephonically
advocate for the patient throughout the care continuum
identify opportunities for workflow improvements and partnerships
maintain real-time records of patient transitions
engage with physicians, case managers, and hospitalists
coordinate follow-up care, medication reconciliation, and discharge planning
collaborate with internal stakeholders and regional leaders on transitions initiatives
participate in training, documentation, tracking, and quality assurance

What we offer

Mission-focused career
paid vacation and sick time
investment/retirement 401K match options
health insurance, vision, and dental benefits
affordable medical plan options
no-cost programs for health and wellness
tuition assistance
flexible schedules
family leave
dependent care resources

Fulltime

New

Weekend position. Saturday and Sunday 8a - 6p. Must also be able to join 30 minu...

Location

United States , Charlotte

Salary:

38.20 - 57.30 USD / Hour

Advocate Health Care

Expiration Date

Until further notice

Requirements

Graduate of an accredited school of nursing required
BSN preferred
Current RN license or temporary license as a Registered Nurse Petitioner in the state in which you work and reside
Minimum of three years nursing experience preferred
Prefer two years in acute health care inpatient setting
home health, managed care, hospice, or case management
Current driver's license

Job Responsibility

Functions as a liaison for patient/family in navigating the continuum of care
Assesses, plans, coordinates, and evaluates services of patients with the goal of equipping and empowering individuals and their families to easily assess resources and adopt healthy lifestyles
Works closely with hospitals, clinics, health care facilities, and agency clinical and administrative personnel to ensure patient care is seamless, efficient, effective and appropriate
Interacts daily with patients, medical professionals, and the community to achieve continuity of care, coordination of medical services, and to document plans of care as related to home health care and hospice services
Makes on-site consultative, educational visits in the hospital to evaluate the appropriateness of the patient's admission to continuing care services
Completes accurate and appropriate documentation, logs, and/or patient forms and records to ensure compliance with regulations, agency policy, payer requirements, and standards of care

What we offer

Paid Time Off programs
Health and welfare benefits such as medical, dental, vision, life, and Short- and Long-Term Disability
Flexible Spending Accounts for eligible health care and dependent care expenses
Family benefits such as adoption assistance and paid parental leave
Defined contribution retirement plans with employer match and other financial wellness programs
Educational Assistance Program

Parttime

Registered Nurse – Hospice Admission

This is a community-based role and will require regular travel in local and rura...

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

Graduation from a qualified, nationally-accredited nursing program
One (1) year of nursing experience in an acute care setting
Current RN licensure permitting work in the State of Arizona
Basic Life Support (BLS) certification required
For Outpatient Hospice & Pediatrics areas, valid Arizona Fingerprint Clearance Card within 6 months of hire
Must have access to a vehicle, a valid driver's license, and current insurance
Knowledge of direct patient care and critical care procedures and techniques
Knowledge of the death/dying and bereavement process
Skill in communicating in a clear and concise manner
Ability to read and interpret documents such as safety rules and procedure manuals

Job Responsibility

Provides patient assessments in various settings to facilitate a well-coordinated, smooth transition to TMC Hospice services
Obtains initial medical orders from the referring providers
Assists Intake Department with referral, computer input as needed
Supports the death/dying process
Promotes TMC Hospice services and programs and exceptional customer service to physicians, facility staff, patients, and families
Develops and maintains positive relationships with referral sources
Explains hospice services and benefits to patients, family members, and caregivers
Develops and maintains therapeutic connections and relationships
Performs a comprehensive nursing assessment
Directs and efficiently coordinates the initiation of hospice services, and any other equipment, supplies, external services for hospice clients

Parttime

Registered Nurse – Hospice Admission

This is a community-based role and will require regular travel in local and rura...

Location

United States , Tucson

Salary:

Not provided

Tucson Medical Center

Expiration Date

Until further notice

Requirements

Graduation from a qualified, nationally-accredited nursing program
One (1) year of nursing experience in an acute care setting
Current RN licensure permitting work in the State of Arizona
Basic Life Support (BLS) certification required
For Outpatient Hospice & Pediatrics areas, valid Arizona Fingerprint Clearance Card within 6 months of hire
Must have access to a vehicle, a valid driver's license, and current insurance
Knowledge of direct patient care and critical care procedures and techniques
Knowledge of the death/dying and bereavement process
Skill in communicating in a clear and concise manner
Ability to read and interpret documents such as safety rules

Job Responsibility

Provides patient assessments in various settings to facilitate a well-coordinated, smooth transition to TMC Hospice services
Obtains initial medical orders from the referring providers
Assists Intake Department with referral, computer input as needed
Supports the death/dying process
Promotes TMC Hospice services and programs and exceptional customer service to physicians, facility staff, patients, and families
Develops and maintains positive relationships with referral sources
Supports programs, organizational, and departmental policies, goals, and objectives
Explains hospice services and benefits to patients, family members, and caregivers
Develops and maintains therapeutic connections and relationships
Performs a comprehensive nursing assessment

Fulltime

RN Care Manager

Inpatient Care Managers are Registered Nurses who independently assure patients ...

Location

United States , Salem

Salary:

52.52 - 80.11 USD / Year

Kaiser Permanente

Expiration Date

Until further notice

Requirements

Minimum of two years combine RN experience in the following areas: Med/Surg (hospital acute care)
ICU (hospital acute care)
Emergency Department
Home Health
Skilled Nursing Facilities
Hospice
Long Term Acute Care
Inpatient Rehab
Utilization Management
Successful completion of an RN program by date of hire

Job Responsibility

Independently assure patients are admitted to the correct level of care for accurate billing and reimbursement
Provide quality, cost effective clinical coordination/care management in acute care and emergency care settings
Manage patients with routine and complex transition planning needs by: independently assessing needs, developing and implementing plans of care for transitions across care settings
Serve as expert consultants and educators for physicians and other health care team members for discharge and transitional care, coordination of internal and community resources
Support the evaluation and improvement of systems of care to support the optimal utilization of health care resources, while maintaining quality of patient care
Assume primary accountability for anticipating, assessing, developing, implementing, documenting, advising, and communicating a safe transition plan of care for patients with complex care needs
Coordinates post-discharge patient care needs to assure the timely and effective discharge of routine and complex patients from the hospital setting
Independently and proactively completes and documents patient assessments which are thorough, timely, age appropriate, and reflect psychosocial support systems, care needs, health plan benefits, level of care determinations for hospitalized patients
Coordinates and communicates with patients, families, and the health care team to develop mutually agreeable plans of care that optimize the use of resources to support the particular needs of individual patients
Facilitates resolution of issues which present barriers to safe transfers through the use of patient/team care conferences to assure the efficient transition to a lower level of care and to assure the patient/family receives the right care at the right time so that quality and utilization of resources are simultaneously enhanced

What we offer

Medical, Vision & Dental
Retirement Plans
Tuition Reimbursement
Supportive Teams & Resources
Career Growth & Development

Parttime

RN Care Coordinator

The RN Care Coordinator is responsible for overseeing the progression of care an...

Location

United States , Los Angeles

Salary:

56.99 - 76.01 USD / Hour

CommonSpirit Health

Expiration Date

Until further notice

Requirements

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
California RN license
AHA BLS card
LA City Fire Card required within 90 days of hire
Ability to pass annual Inter-rater reliability test for Utilization Review product(s) used
Able to apply clinical guidelines to ensure progression of care
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

Job Responsibility

Overseeing the progression of care and discharge planning for identified patients requiring these services
Perform this role to meet the individual's health needs while promoting quality of care, cost effective outcomes and by following hospital policies, standards of practice and Federal and State regulations
Care coordination, communication and collaboration with utilization management, nursing, physicians, ancillary departments, insurers and post acute service providers to progress the care toward optimal outcomes at the appropriate level of care
Advocate for the patient and family by identifying, valuing, and addressing patient choice, spiritual needs, cultural, language and socioeconomic barriers to care transitions
Strive to enhance the patient experience

What we offer

Sign-On Bonus not to exceed 10% of salary for qualified and experienced candidates
Medical, prescription drug, dental, vision plans
Life insurance
Paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
Tuition reimbursement
Retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

Rn transition coordinator - transition services

Advocate Health Care

Location:
United States , Charlotte

Category:
Nursing

Contract Type:
Not provided

Salary:

Job Description:

Job Responsibility:

Requirements:

Additional Information:

Job Posted:
February 11, 2026

Looking for more opportunities? Search for other job offers that match your skills and interests.

Similar Jobs for Rn transition coordinator - transition services

Embedded Transitional Care Manager RN

Care Transitions Coordinator RN/LPN Clinical Sales

Embedded Transitional Care Manager