Discharge & Care Transition Navigator

AbsoluteCARE Medical Center & Pharmacy; United States; On-site; USD 70,000 - 95,000; Full time

Job summary

AbsoluteCare Medical Center & Pharmacy in the United States seeks a Transitional Care Manager (RN) to lead discharge planning and care coordination for hospitalized members. You will develop PCCPs, collaborate with inpatient teams, PCPs, and community resources to ensure safe transitions.

This role requires travel up to 80% locally, strong clinical judgement, and proficiency with MS Office and EMR systems. You will monitor KPIs, reduce readmissions, and advocate for members across the continuum

Qualifications

• Must hold an active RN license in the state of practice.
• CCM or CCTM credentials a plus.
• 3+ years serving medically complex populations in community or office settings.
• Experience with discharge planning, care transitions, and case management.
• Excellent written and verbal communication and computer skills.

Responsibilities

• Meet with inpatient members to develop PCCP addressing discharge needs.
• Call post-discharge to review instructions and schedule follow-up visits.
• Coordinate post-discharge plans with PCPs, specialists, and home health.
• Communicate with internal and external care teams to resolve barriers.
• Attend clinical rounds and provide discharge recommendations.
• Maintain privacy and security of member information.
• Meet established KPIs and manage caseload per frequency requirements.

Skills

Discharge planning

Care coordination

Clinical judgement

Communication skills

Travel up to 80%

MS Office proficiency

Inpatient & community care

Bilingual desirable

Education

Active RN license (state practice)

CCM or CCTM credentials a plus

Tools

Microsoft Office Suite

Job description

AbsoluteCare Medical Center & Pharmacy in the United States seeks a Transitional Care Manager (RN) to lead discharge planning and care coordination for hospitalized members. You will develop PCCPs, collaborate with inpatient teams, PCPs, and community resources to ensure safe transitions.

This role requires travel up to 80% locally, strong clinical judgement, and proficiency with MS Office and EMR systems. You will monitor KPIs, reduce readmissions, and advocate for members across the continuum