Remote RN Care Transitions Coach

Molina Healthcare; California; Remote; USD 32,000 - 70,000; Full time

Benefits offered by this job

Remote work

Job summary

Molina Healthcare is seeking a Remote RN Transition of Care Coach to guide hospital-to-home care transitions. The role emphasizes proactive care coordination, patient education, and reducing readmissions for members across the care continuum.

The RN will partner with discharge planners and providers, conduct 30-day post-discharge follow-ups, and support medication management, care plans, and home visits as needed.

Qualifications

• Active RN license in state of practice.
• 2+ years in health care with 1 year in discharge planning or care management.
• Knowledge of Care Transitions Interventions (CTI) or similar model.

Responsibilities

• Follow members through a 30-day program from hospital admission to discharge.
• Collaborate with discharge planners and outpatient providers for safe transitions.
• Ensure caregiving and functional support during member transitions.
• Coordinate with ancillary providers for services and equipment.
• Conduct face-to-face hospital visits and home visits for high-risk members post-discharge.
• Coordinate care and reassess needs using the Coleman Care Transition model.
• Educate members on medication management and follow-up care.
• Use motivational interviewing to support members.

Education

Registered Nurse (RN) License - active

Job description

Molina Healthcare is seeking a Remote RN Transition of Care Coach to guide hospital-to-home care transitions. The role emphasizes proactive care coordination, patient education, and reducing readmissions for members across the care continuum.

The RN will partner with discharge planners and providers, conduct 30-day post-discharge follow-ups, and support medication management, care plans, and home visits as needed.