Hospital-to-Home Care Transition Navigator

VitalCaring Group

Independence (MO)

On-site

USD 65,000 - 85,000

Full time

14 days+

Application generator

Turn this role into an interview — a resume and cover letter built around what this employer wants.

Get past ATS filters

Benefits offered by this job

Medical, Dental, Vision

Virtual care

FSA/HSA

Supplemental insurance

401(k) match

Employee referral

Legal services

Identity theft protection

Paid time off

Education reimbursement

Job summary

VitalCaring is seeking a Care Transition Navigator (CTN) – Home Health to join our hospital-focused care team. You will coordinate transitions from hospital to home health, working with case managers, physicians, patients and families to reduce readmissions and improve outcomes.

This field-based role requires clinical insight, strong communication, and hands-on care coordination across multidisciplinary teams. You will help ensure timely admissions and seamless patient transitions.

Qualifications

Active RN, LVN/LPN, or PT license in the state of employment.
Minimum of two years of clinical experience; home health or post-acute preferred.
Experience in healthcare coordination, case management, or hospital-based roles.
Strong understanding of patient care transitions, discharge planning, or post-acute services.
Excellent communication skills with patients, families, and clinicians.

Responsibilities

Serve as primary liaison between hospital teams, patients, and VitalCaring clinicians for smooth transitions.
Conduct bedside assessments to identify clinical needs and barriers to discharge.
Partner with case managers and physicians to develop safe transition plans.
Drive timely admissions by coordinating referrals and handoffs to home health services.
Build trusted relationships with hospital partners through clear communication.
Complete post-discharge follow-up within 48 hours and coordinate primary care as needed.
Collaborate with internal teams to improve outcomes and reduce readmissions.