Care Transitions Specialist

Compassus; Mission Viejo (CA); On-site; USD 56,000 - 84,000; Full time

Job summary

Compassus in California is seeking a Care Partner to coordinate safe transitions of care for hospitalized patients. You will evaluate patients for home-based post-acute services and support timely discharge planning with physicians, case management, families, and post-acute providers.

This in-person role focuses on reducing length of stay and readmissions, improving patient outcomes, and ensuring the right care at the right time through bedside collaboration and comprehensive care coordination.

Qualifications

• Education: Associate's degree required; Bachelor's preferred.
• Experience: None required; 2–3 years in healthcare preferred (hospital/long-term care).

Responsibilities

• Evaluate patients for home-based and post-acute care services based on clinical, functional, psychosocial, and environmental factors.
• Review inpatient referrals and prioritize patients using clinical judgment and analytics.
• Coordinate discharge planning and arrange post-acute services including home health and follow-up care.
• Educate patients and families on post-acute options and care expectations.
• Maintain referrals and coordinate handoffs to post-acute providers.
• Participate in interdisciplinary rounds and care coordination discussions.
• Support value-based care and site-of-care decisions.

Skills

Discharge coordination

Care transitions

Healthcare communications

English proficiency

Education

Associate's degree

Bachelor's degree preferred

Tools

Electronic Medical Records (EMR) systems

Job description

Compassus in California is seeking a Care Partner to coordinate safe transitions of care for hospitalized patients. You will evaluate patients for home-based post-acute services and support timely discharge planning with physicians, case management, families, and post-acute providers.

This in-person role focuses on reducing length of stay and readmissions, improving patient outcomes, and ensuring the right care at the right time through bedside collaboration and comprehensive care coordination.