Care Transition Navigator - Home Health (RN/LPN/PT)

Vitalcaring-Group; Dallas (TX); Vor Ort; USD 70.000 - 95.000; Vollzeit

Benefits dieser Stelle

Medical/Dental/Vision coverage

401(k) match

Tuition reimbursement

Employee referral program

Flexible Spending Accounts

Zusammenfassung

VitalCaring is seeking a Care Transition Navigator (CTN) for hospital-to-home health coordination. This field-based role partners with hospital teams, physicians, patients, and families to coordinate care, reduce readmissions, and improve outcomes.

You will conduct bedside assessments, develop transition plans, and ensure timely admissions to home health services while building strong partnerships across care teams. A valid license in RN/LVN/LPT and post-acute experience are preferred.

Qualifikationen

• Active RN, LVN/LPN, or PT license in the state of employment (or compact eligibility).
• Minimum of two years of clinical experience; home health or post-acute experience preferred.
• Experience in healthcare coordination, case management, clinical care, or hospital-based roles.
• Strong understanding of patient care transitions, discharge planning, or post-acute services.
• Demonstrated ability to build relationships with healthcare providers and interdisciplinary teams.
• Excellent communication skills with the ability to engage patients, families, and clinicians effectively.
• High level of organization with the ability to manage multiple patients and priorities simultaneously.

Aufgaben

• Serve as primary liaison between hospital teams, patients, and VitalCaring clinicians to ensure seamless transitions from hospital to home.
• Conduct bedside assessments to identify clinical needs, risk factors, and barriers to successful discharge.
• Partner with case managers and physicians to develop and execute safe, patient-centered transition plans.
• Drive timely admissions by coordinating referrals and ensuring smooth handoffs into home health services.
• Build strong, trusted relationships with hospital partners through consistent communication and follow-through.
• Complete post-discharge follow-up within 48 hours and ensure timely primary care coordination.
• Collaborate with internal teams and support initiatives focused on improving outcomes and reducing readmissions.

Kenntnisse

RN/LVN/PT license

Clinical experience

Healthcare coordination

EMR proficiency

Driver's license

Ausbildung

Active RN/LVN/LPN or PT license

Tools

EMR systems (HCHB)

Homecare Homebase (HCHB)

Jobbeschreibung

VitalCaring is seeking a Care Transition Navigator (CTN) for hospital-to-home health coordination. This field-based role partners with hospital teams, physicians, patients, and families to coordinate care, reduce readmissions, and improve outcomes.

You will conduct bedside assessments, develop transition plans, and ensure timely admissions to home health services while building strong partnerships across care teams. A valid license in RN/LVN/LPT and post-acute experience are preferred.