Discharge & Care Transitions RN

AbsoluteCare; Cincinnati (OH); On-site; USD 70,000 - 100,000; Full time

Job summary

AbsoluteCare is seeking a Transitional Care Manager (RN) to support in-person discharge planning, care coordination, and integrated case management for members admitted to inpatient facilities. You will coordinate with hospital teams, PCPs, and community resources to meet post-discharge needs and improve value-based outcomes.

The role requires travel up to 80% to local hospitals, SNFs, and residential treatment facilities, along with strong clinical judgment and collaboration with health plan

Qualifications

• Must be a licensed RN in the state of practice.
• Active CPR certification.
• Excellent written and verbal communication skills.
• Ability to work independently and exercise clinical judgement.
• Travel up to 80% to local facilities for member visits and relationship building.

Responsibilities

• Meet with members during inpatient admission to develop a PCCP for discharge and transition needs.
• Call members post discharge to review instructions, reconcile meds, and schedule follow-ups.
• Coordinate post-discharge plans with primary care providers, specialists, and home health services.
• Communicate with AbsoluteCare on discharge plans and barriers to safe discharge.
• Manage PCCP and member contact in line with policies and accreditation standards.
• Provide education with teach-back on medical, behavioral, and health-condition topics.

Skills

Discharge planning

Care coordination

Communication skills

Problem solving

Driving

Education

RN license (state-licensed)

Tools

Microsoft Office

Job description

AbsoluteCare is seeking a Transitional Care Manager (RN) to support in-person discharge planning, care coordination, and integrated case management for members admitted to inpatient facilities. You will coordinate with hospital teams, PCPs, and community resources to meet post-discharge needs and improve value-based outcomes.

The role requires travel up to 80% to local hospitals, SNFs, and residential treatment facilities, along with strong clinical judgment and collaboration with health plan