Hospital-to-Home Care Transition Navigator

VitalCaring Group; Dallas (TX); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

Medical, Dental, Vision

401(k) with company match

Tuition reimbursement

Flexible Spending Accounts

Life insurance

Employee referral program

Identity theft protection

Job summary

VitalCaring Group is seeking a Care Transition Navigator (CTN) – Home Health to ensure safe, seamless hospital-to-home transitions. You will work directly with hospital teams, case managers, physicians, patients, and families to coordinate care, reduce readmissions, and improve patient outcomes.

This field-based role blends clinical insight with care coordination and referral management to support patient success and agency growth. Strong EMR skills and a valid license are required.

Qualifications

• Active RN, LVN/LPN, or PT license in the state of employment.
• Minimum of two (2) years of clinical experience; home health or post-acute experience preferred.
• Experience in healthcare coordination, case management, clinical care, or hospital-based roles.
• Strong understanding of patient care transitions, discharge planning, or post-acute services.

Responsibilities

• Serve as liaison between hospital teams, patients, and VitalCaring clinicians for transitions.
• Conduct bedside assessments to identify clinical needs and barriers to discharge.
• Partner with case managers and physicians on transition plans.
• Coordinate referrals and ensure smooth handoffs into home health services.
• Build relationships with hospital partners through clear communication.

Skills

Communication skills

Organization

Time management

Interdisciplinary collaboration

Education

RN/LVN/LPN license

Tools

EMR systems

Job description

VitalCaring Group is seeking a Care Transition Navigator (CTN) – Home Health to ensure safe, seamless hospital-to-home transitions. You will work directly with hospital teams, case managers, physicians, patients, and families to coordinate care, reduce readmissions, and improve patient outcomes.

This field-based role blends clinical insight with care coordination and referral management to support patient success and agency growth. Strong EMR skills and a valid license are required.