Care Transition Navigator: Hospital to Home Health Impact

Alliance for Care at Home; Independence (MO); Sur place; USD 65 000 - 85 000; Plein temps

Avantages offerts par ce poste

Medical benefits

Dental and vision

401(k) match

Education reimbursement

Paid time off

Résumé du poste

VitalCaring is seeking a Care Transition Navigator (CTN) to coordinate safe hospital-to-home transitions and join a field-based role focused on patient care coordination. You will work within hospital systems, partnering with case managers and physicians to reduce readmissions and improve outcomes.

This high-impact position requires active nursing or PT licensure in the employing state, 2+ years of clinical experience, and proficiency with EMR systems. Travel and driver’s license are required.

Qualifications

• Active RN, LVN/LPN, or PT license in the state of employment.
• 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.
• Proficiency with EMR systems and basic computer applications.

Responsabilités

• Serve as the primary liaison between hospital teams, patients, and VitalCaring clinicians to ensure seamless transitions from hospital to home health.
• 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 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.

Connaissances

Clinical coordination

Case management

EMR proficiency

Discharge planning

Communication skills

Driving

Formation

RN license

LPN/LVN license

PT license

Description du poste

VitalCaring is seeking a Care Transition Navigator (CTN) to coordinate safe hospital-to-home transitions and join a field-based role focused on patient care coordination. You will work within hospital systems, partnering with case managers and physicians to reduce readmissions and improve outcomes.

This high-impact position requires active nursing or PT licensure in the employing state, 2+ years of clinical experience, and proficiency with EMR systems. Travel and driver’s license are required.