Care Transitions Specialist - Hospital to Home

AbsoluteCare; Chicago (IL); On-site; USD 34,000 - 37,000; Full time

Job summary

AbsoluteCare in Chicago is seeking a Care Navigator to help reduce unnecessary hospital readmissions by visiting admitted members, addressing post-discharge needs, and ensuring seamless transitions of care following discharge.

The role covers acute and post-acute facilities in the community, where you will connect members to AbsoluteCare services, schedule follow-ups, and document activities in our care management system.

Qualifications

• 80% onsite in hospitals, SNFs, and residential treatment facilities to engage members and build relationships with discharge planners and case management staff.
• High School diploma or equivalent.
• CNA, Certified MA-preferred, or CHW with prior hospital experience required.
• CPR/BLS certification required.
• 3+ years in patient-facing healthcare environments; hospital experience preferred.
• Experience in SNF, hospital, or physician office settings is required.
• Excellent communication and rapport-building skills; ability to work independently.

Responsibilities

• Engage in person with admitted members in hospitals and healthcare facilities to engage and build lasting rapport.
• Conduct CN screenings and identify gaps in care, post-discharge risks, escalate to clinical support.
• Participate in Huddles to provide member updates and handoffs to center or POD teams.
• Facilitate post-discharge follow-up appointments with absolute care teams.
• Ensure member has post-discharge medications and required equipment as ordered.
• Document all interactions timely in the care management system.
• Collaborate with interdisciplinary teams to support safe transitions of care to home.

Skills

Onsite engagement

CNA/CHW background

Strong communication

Driver's license

Bilingual desirable

Education

High School diploma or equivalent

Job description

AbsoluteCare in Chicago is seeking a Care Navigator to help reduce unnecessary hospital readmissions by visiting admitted members, addressing post-discharge needs, and ensuring seamless transitions of care following discharge.

The role covers acute and post-acute facilities in the community, where you will connect members to AbsoluteCare services, schedule follow-ups, and document activities in our care management system.