Post Acute Care Coordinator

Palm Beach Accountable Care Organization; Atlanta (GA); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Travel reimbursement

Collaborative work environment

Opportunities for career growth

Job summary

Palm Beach Accountable Care Organization in Atlanta, Georgia is looking for a Post Acute Transition Coordinator to enhance patient outcomes and facilitate effective transitions from hospital to home or post-acute care. This role requires a Bachelor’s degree and at least 2 years of relevant experience in a healthcare setting. The Coordinator will develop personalized care plans, monitor post-discharge progress, and actively support patients and families. The position involves significant local travel to care facilities, making flexibility and reliability essential for success.

Qualifications

• 2+ years of experience in care coordination, case management, or discharge planning within a healthcare environment.
• Strong understanding of post-acute care services and patient discharge processes.
• Proficiency with EHR systems and care management software.

Responsibilities

• Coordinate seamless care transitions from hospital discharge to skilled nursing or rehab services.
• Develop individualized care plans by collaborating with healthcare professionals.
• Monitor progress post-discharge and address barriers to care.

Skills

Care coordination

Case management

Strong communication skills

Organizational skills

EHR system proficiency

Education

Bachelor’s degree in Nursing, Social Work, or related field

Tools

MS Office

Healthcare data tools (MS Project, Smartsheet, Asana)

Job description

Shape the Future of Post-Acute Care Coordination

Are you passionate about improving patient outcomes and ensuring smooth care transitions? Join our Network Development Team as a Post Acute Transition Coordinator — a vital role that bridges hospitals, patients, and post‑acute providers to deliver seamless, compassionate care during one of the most critical stages of recovery.

As a trusted care connector, you’ll coordinate the journey from hospital to home or post‑acute care facilities, ensuring each patient receives the support, resources, and follow‑up they need to thrive. Your work will help reduce readmissions, strengthen partnerships, and elevate the quality of care across our network.

What You’ll Do

• Coordinate seamless care transitions from hospital discharge to skilled nursing, rehab, or home‑based services.
• Develop individualized care plans by collaborating with physicians, nurses, social workers, and families.
• Communicate across settings to ensure continuity, timely documentation, and exceptional patient experiences.
• Monitor progress post‑discharge and proactively address barriers to care or readmission risks.
• Promote best practices and compliance with all care coordination and regulatory standards.
• Serve as a trusted advocate for patients and families navigating complex healthcare systems.

What You Bring

Minimum Qualifications

• Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or related field
• 2+ years of experience in care coordination, case management, or discharge planning within a healthcare environment
• Strong understanding of post‑acute care services and patient discharge processes
• Excellent communication, collaboration, and organizational skills
• Proficiency with EHR systems and care management software

Preferred Qualifications

• Registered Nurse (RN) license or Certified Case Manager (CCM) credential
• Experience supporting diverse or complex patient populations
• Familiarity with Medicare, Medicaid, and insurance authorization processes
• Training in motivational interviewing or patient advocacy
• Advanced certifications in care coordination or transitions of care

Your Strengths

• Skilled at juggling multiple patient cases while keeping care quality front and center
• Analytical thinker who can identify risks and implement effective care plans
• Relationship‑builder who fosters trust and cooperation across multidisciplinary teams
• Confident navigating healthcare regulations and insurance systems
• Tech‑savvy professional with proficiency in MS Office and healthcare data tools (MS Project, Smartsheet, Asana, etc.)

Why You’ll Love Working Here

• Make a measurable impact on patients’ recovery journeys and long‑term well‑being
• Collaborate with mission‑driven professionals who share your passion for high‑quality care
• Grow your career through exposure to diverse healthcare systems and innovative care coordination practices
• Enjoy flexibility across regional roles (Southwest, Central, Northwest) with a supportive leadership team that values balance, integrity, and collaboration

Travel & Field Engagement Requirements

This role includes a significant in‑person component. Approximately 50% of the position involves local travel to Skilled Nursing Facilities and other post‑acute care settings to build relationships, support network growth, and establish ongoing meeting cadence with partner facilities. Candidates must be comfortable with frequent travel, have reliable personal transportation, and be willing to conduct regular on‑site visits. Travel expenses will be reimbursed.

Physical Demands

This position requires periods of sitting, standing, and working at a computer. Occasional lifting (up to 10 lbs) may be needed.

Equal Opportunity Employer

We celebrate diversity and are committed to creating an inclusive environment for all employees.

Ready to make a difference in how patients experience post‑acute care? Apply today and help redefine what successful care transitions look like.