Remote Transitions of Care APP — Post-Discharge Specialist

Devoted Health; Athens (GA); On-site; USD 120,000 - 150,000; Full time

Benefits offered by this job

Health, dental, and vision insurance

Generous paid time off

$100 monthly mobile stipend

Stock options

Bonus eligibility

Parental leave

401(k) plan

Job summary

Devoted Health is seeking an experienced Advanced Practice Provider (APRNs and PAs) to lead our Medical Transitions of Care (TOC) program. This role blends acute post‑discharge visits with longitudinal chronic‑care planning, within a highly collaborative team of clinicians and care coordinators.

You will shape the TOC program and contribute to quality improvement. The role requires full‑time availability, strong clinical judgment, and comfort with telehealth and in‑home coordination.

Qualifications

• Experience delivering care to geriatric patients with multiple chronic conditions.
• Experience managing post‑discharge transitions and TOC programs.
• Ability to work full-time with standard US clinic hours.

Responsibilities

• Conduct comprehensive initial TOC visits and full post‑discharge assessments.
• Perform acute/virtual urgent‑care TOC visits and determine level of care.
• Manage the 30‑day clinical trajectory and adjust care plans.
• Participate in interdisciplinary TOC rounds and collaborate with care teams.
• Support EHR improvements and participate in quality‑improvement projects.

Skills

Geriatric care

Acute and chronic care

Telehealth visits

Team collaboration

Clinical judgment

Job description

Devoted Health is seeking an experienced Advanced Practice Provider (APRNs and PAs) to lead our Medical Transitions of Care (TOC) program. This role blends acute post‑discharge visits with longitudinal chronic‑care planning, within a highly collaborative team of clinicians and care coordinators.

You will shape the TOC program and contribute to quality improvement. The role requires full‑time availability, strong clinical judgment, and comfort with telehealth and in‑home coordination.