Care Transition & Discharge Coordinator

Providence at Home with Compassus; Edmonds (WA); On-site; USD 62,474 - 93,690; Full time

Benefits offered by this job

Competitive pay

Flexible time off

Tuition reimbursement

Wellness programs

Job summary

Providence at Home with Compassus is seeking a Clinical Care Partner to coordinate safe, patient-centered transitions from hospital to home. You will assess post-acute care needs, support discharge planning with physicians and care teams, and arrange services such as home health or hospice.

The role emphasizes bedside engagement, interdisciplinary collaboration, and active participation in discharge workflows, with a strong focus on reducing readmissions and improving outcomes.

Qualifications

• RN/LMSW/LCSW/LICSW licensure required; CPR certification.
• Education aligned with healthcare delivery and post-acute care.
• Experience in care coordination or discharge planning preferred.

Responsibilities

• Evaluate patients for home-based and post-acute care services.
• Coordinate timely, safe discharge planning and transitions.
• Educate patients and families on post-acute care options and processes.
• Maintain and strengthen referral network with hospital and post-acute providers.
• Identify patients suitable for hospice or GIP level of care.

Skills

Clinical communication

Discharge planning

Multitasking

Team collaboration

Education

Associate’s degree in Nursing/Health Sciences

Bachelor’s degree in nursing/Health Sciences

Tools

Epic EMR

Referral platforms

Job description

Providence at Home with Compassus is seeking a Clinical Care Partner to coordinate safe, patient-centered transitions from hospital to home. You will assess post-acute care needs, support discharge planning with physicians and care teams, and arrange services such as home health or hospice.

The role emphasizes bedside engagement, interdisciplinary collaboration, and active participation in discharge workflows, with a strong focus on reducing readmissions and improving outcomes.