Hospital-to-Home Care Transition Navigator

vitalcaringgroup; Lafayette (LA); Vor Ort; USD 65.000 - 85.000; Vollzeit

Benefits dieser Stelle

Medical, Dental, and Vision coverage

401(k) with company match

Flexible Spending Accounts (FSA) and H

Life insurance

Paid time off

Zusammenfassung

VitalCaring is seeking a Care Transition Navigator (CTN) to ensure safe, seamless transitions from hospital to home health. You will work with hospital systems, case managers, physicians, patients, and families to coordinate care and reduce readmissions.

This field-based role blends clinical insight with care coordination and referral management to support patient success and agency growth.

Qualifikationen

• Active RN, LVN/LPN, or PT license in the state of employment (or compact eligibility).
• Minimum of two years of clinical experience; home health or post-acute experience preferred.
• Experience in healthcare coordination, case management, clinical care, or hospital-based roles.

Aufgaben

• Serve as the primary liaison between hospital teams, patients, and VitalCaring clinicians to ensure seamless transitions from hospital to home.
• Conduct bedside assessments to identify clinical needs, risk factors, and barriers to discharge.
• Partner with case managers and physicians to develop and execute safe, patient-centered transition plans.
• Drive timely admissions by coordinating referrals and ensuring smooth handoffs into home health services.
• Build strong relationships with hospital partners through consistent communication and follow‑through.
• Complete post-discharge follow-up within 48 hours and ensure timely primary care coordination.
• Collaborate with internal teams to improve outcomes and reduce readmissions.

Kenntnisse

Clinical coordination

Discharge planning

Communication

EMR proficiency

Patient and family engagement

Time management

Ausbildung

RN/LVN/LPT license (state)

Bachelor's in Nursing or related field (preferred)

Jobbeschreibung

VitalCaring is seeking a Care Transition Navigator (CTN) to ensure safe, seamless transitions from hospital to home health. You will work with hospital systems, case managers, physicians, patients, and families to coordinate care and reduce readmissions.

This field-based role blends clinical insight with care coordination and referral management to support patient success and agency growth.