Impactful Care Transition Navigator for Hospital to Home

VitalCaring Group; Lafayette (LA); On-site; USD 65,000 - 85,000; Full time

Benefits offered by this job

Medical coverage

Dental coverage

Vision coverage

401(k) with company match

Paid time off

Job summary

VitalCaring Group is seeking a Care Transition Navigator (CTN) – Home Health to coordinate hospital-to-home transitions. This field-based role partners with hospital teams, physicians, patients, and families to reduce readmissions and improve patient outcomes.

The CTN blends clinical insight with care coordination and referral management, supporting both patient success and agency growth in a fast-paced healthcare environment.

Qualifications

• 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.
• Strong understanding of patient care transitions, discharge planning, or post-acute services.

Responsibilities

• Serve as liaison between hospital teams, patients, and VitalCaring clinicians to ensure seamless transitions from hospital to home.
• Conduct bedside assessments to identify clinical needs and barriers to discharge.
• Partner with case managers and physicians to develop safe, patient-centered transition plans.
• Drive timely admissions by coordinating referrals and handoffs into home health services.
• Build strong relationships with hospital partners through consistent communication.

Skills

Excellent communication

Time management

Interdisciplinary collaboration

Education

Active RN/LVN/LPN/PT license in state of employment

Tools

EMR systems

Job description

VitalCaring Group is seeking a Care Transition Navigator (CTN) – Home Health to coordinate hospital-to-home transitions. This field-based role partners with hospital teams, physicians, patients, and families to reduce readmissions and improve patient outcomes.

The CTN blends clinical insight with care coordination and referral management, supporting both patient success and agency growth in a fast-paced healthcare environment.