Impactful Care Transition Navigator – Home Health

VitalCaring Group; Lake Charles (LA); On-site; USD 60,000 - 90,000; Full time

Benefits offered by this job

Medical/Dental/Vision

Virtual care

FSA/HSA

401(k) match

Referral program

Tuition reimbursement

Paid time off

Life insurance

Identity theft protection

Job summary

VitalCaring Group is seeking a Care Transition Navigator (CTN) to coordinate hospital-to-home health transitions. This field-based role works with case managers, physicians, patients, and families to reduce readmissions and improve outcomes.

The position emphasizes clinical insight, care coordination, and referral management to support patient success and agency growth. Strong EMR proficiency is required.

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, clinical care, or hospital-based roles.
• Strong understanding of patient care transitions, discharge planning, or post-acute services.
• Excellent communication skills with patients, families, and clinicians.
• Proficiency with EMR systems and basic computer applications.
• Valid driver’s license and reliable transportation.

Responsibilities

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

Skills

RN License

LVN/LPN License

PT License

Healthcare Coordination

Case Management

Discharge Planning

Communication Skills

EMR Proficiency

Driver's License

Tools

EMR Systems

Job description

VitalCaring Group is seeking a Care Transition Navigator (CTN) to coordinate hospital-to-home health transitions. This field-based role works with case managers, physicians, patients, and families to reduce readmissions and improve outcomes.

The position emphasizes clinical insight, care coordination, and referral management to support patient success and agency growth. Strong EMR proficiency is required.