Remote RN Transition Coach - 30-Day Readmissions

IntelliResume; Kansas; Hybrid; USD 36,000 - 71,000; Full time

Benefits offered by this job

Competitive benefits package

Job summary

Molina Healthcare, a leading healthcare provider, seeks a Transition of Care Coach to support care transitions from hospital to home or other settings. The role focuses on proactive coordination to reduce readmissions and ensure seamless care for members.

The position is remote with full-time hours in the United States, requiring an active RN license, 2+ years in healthcare with discharge planning experience, and a valid driver's license.

Qualifications

• RN license active and unrestricted in the state of practice.
• Minimum 2 years experience in health care, with at least 1 year in discharge planning, care management, or behavioral health.

Responsibilities

• Follow members through a 30-day program from admission to transitions.
• Collaborate with discharge planners, hospitalists, outpatient providers, and families.
• Ensure transitions to settings with adequate caregiving and functional support.
• Coordinate care with ancillary providers and public agencies to arrange services.
• 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 change during contacts.
• Assess barriers to care and coordinate solutions.
• Facilitate interdisciplinary care team meetings.

Skills

Care coordination

Discharge planning

Motivational interviewing

Communication skills

Education

Registered Nurse (RN) license

Tools

Care Transitions Intervention (CTI)

Job description

Molina Healthcare, a leading healthcare provider, seeks a Transition of Care Coach to support care transitions from hospital to home or other settings. The role focuses on proactive coordination to reduce readmissions and ensure seamless care for members.

The position is remote with full-time hours in the United States, requiring an active RN license, 2+ years in healthcare with discharge planning experience, and a valid driver's license.