Discharge & Post-Acute Care Navigator

Compassus; Jacksonville (FL); On-site; USD 65,000 - 90,000; Full time

Benefits offered by this job

Tuition reimbursement

Wellness programs

Flexible time off

Job summary

Compassus seeks a Clinical Care Partner to coordinate safe transitions of care from hospital to home-based services. You will assess patients for home health, hospice, DME, and other post-acute needs, and support discharge planning with physicians, case management, patients, and families.

This in-person role requires bedside engagement and active collaboration across hospital teams and post-acute providers to improve outcomes and reduce readmissions.

Qualifications

• Education must be an associate degree or equivalent.
• Preferred bachelor’s degree in nursing, health sciences, or related field.
• Licensure as RN, LMSW, LCSW, or LICSW is required.
• 2–3 years in care coordination, discharge planning, or post-acute care preferred.
• Experience with EMR systems (Epic) and referral platforms preferred.

Responsibilities

• Coordinate safe, timely hospital discharges and transitions to home-based care.
• Evaluate patients for appropriate post-acute services and care levels.
• Collaborate with physicians, case management, and care teams to plan care.
• Arrange post-acute services including home health, hospice, DME, and medications.
• Educate patients and families on post-acute options and care plans.

Skills

Care coordination

Discharge planning

Communication skills

Multidisciplinary collaboration

Education

Associate’s degree in Nursing, Health Sciences, or related field

Bachelor’s degree in nursing, Health Sciences, or related field

Tools

Epic EMR

Job description

Compassus seeks a Clinical Care Partner to coordinate safe transitions of care from hospital to home-based services. You will assess patients for home health, hospice, DME, and other post-acute needs, and support discharge planning with physicians, case management, patients, and families.

This in-person role requires bedside engagement and active collaboration across hospital teams and post-acute providers to improve outcomes and reduce readmissions.