Care Transitions Architect

Compassus; Apple Valley (CA); On-site; USD 37,000 - 56,000; Full time

Benefits offered by this job

Competitive pay

Flexible time off

Tuition reimbursement

Wellness programs

Job summary

Providence at Home with Compassus seeks a Care Partner to coordinate safe, efficient transitions of care for hospitalized patients and to evaluate eligibility for home-based services. You will collaborate with physicians, case management, patients, families, and post-acute providers to ensure timely and high-quality discharge planning.

The role emphasizes bedside engagement, interdisciplinary collaboration, and alignment with value-based care.

Qualifications

• Education required: Associate's degree; preferred: Bachelor's degree.
• Experience: none required; preferred: 2–3 years in healthcare (hospital/long-term care).
• Liaison, care coordination, partner, and/or discharge planning experience.

Responsibilities

• Coordinate safe, efficient transitions of care for hospitalized patients.
• Evaluate patients for home-based and post-acute care services.
• Facilitate timely discharge planning with clinicians and families.
• Educate patients and families on post-acute options and services.
• Manage referrals and handoffs to post-acute providers.
• Support hospice/GIP coordination where applicable.

Skills

Communication skills

Care coordination

Discharge planning

Education

Associate's degree

Bachelor's degree

Tools

Predictive analytics tools

Job description

Providence at Home with Compassus seeks a Care Partner to coordinate safe, efficient transitions of care for hospitalized patients and to evaluate eligibility for home-based services. You will collaborate with physicians, case management, patients, families, and post-acute providers to ensure timely and high-quality discharge planning.

The role emphasizes bedside engagement, interdisciplinary collaboration, and alignment with value-based care.