Regional Care Transitions Navigator

Healing Partners; Erie (Erie County); On-site; USD 65,000 - 90,000; Full time

Job summary

Healing Partners is seeking a Regional Patient Navigator to support patients transitioning from skilled nursing facilities to suitable post-discharge health services in home settings. The role works onsite within SNFs, identifying needs, coordinating with interdisciplinary teams, and ensuring safe, continuous care at home.

The ideal candidate will have a background in case management, care coordination, social work, or related healthcare roles, and be comfortable traveling to multiple facilities

Qualifications

• Bachelor’s degree required; Master’s degree preferred (MSW, MHA, or related field).
• Background in case management, care coordination, social work, patient advocacy, or related healthcare roles.

Responsibilities

• Establish a consistent presence within assigned SNFs to support post-discharge planning and care transitions.
• Identify patients who may benefit from post-acute health services through collaboration with nursing, social services, and discharge planning teams.
• Educate patients and families on available care options and support informed decision-making for post-discharge services.
• Coordinate referrals and facilitate timely transitions to appropriate post-acute providers.
• Serve as a liaison between SNF staff and post-acute care partners to ensure clear communication and continuity of care.
• Document patient interactions, referrals, and outcomes in accordance with organizational and regulatory standards.
• Build and maintain strong professional relationships within facilities through reliability, responsiveness, and ethical conduct.
• Travel independently between assigned facilities within the designated territory.

Skills

Care coordination

Discharge planning

Patient advocacy

Interpersonal skills

Time management

Education

Bachelor's degree

MSW or related field (preferred)

Job description

Healing Partners is seeking a Regional Patient Navigator to support patients transitioning from skilled nursing facilities to suitable post-discharge health services in home settings. The role works onsite within SNFs, identifying needs, coordinating with interdisciplinary teams, and ensuring safe, continuous care at home.

The ideal candidate will have a background in case management, care coordination, social work, or related healthcare roles, and be comfortable traveling to multiple facilities