RN Care Transition Navigator

Molina Healthcare; Aurora (IL); On-site; USD 39,000 - 74,000; Full time

Job summary

Molina Healthcare in Aurora, IL seeks a Registered Nurse to support care transition activities from hospital admission through post-discharge settings. The role focuses on reducing readmissions, coordinating with discharge planners, hospitalists, and care teams to ensure timely, safe transitions.

The ideal candidate has 2+ years in healthcare with discharge planning experience, an active RN license, and a valid driver's license.

Qualifications

• 2+ years in healthcare, including 1+ year in discharge planning, care management, or behavioral health.
• RN license active and unrestricted.
• Valid driver's license and reliable transportation.
• Knowledge of Care Transitions Intervention (CTI) or similar model.
• Background in discharge planning and/or home health.
• Strong communication, time management, and prioritization skills.
• Ability to work independently and handle high-pressure situations.
• Proficiency with Microsoft Office.

Responsibilities

• Follows member through a 30-day program from hospital admission through transitions to other settings.
• Collaborates with hospital discharge planner, hospitalists, providers, facility staff, and family.
• Ensures safe transitions with adequate caregiving and medical oversight.
• Coordinates with ancillary providers and agencies to arrange services and equipment.
• Conducts face-to-face hospital visits and home visits for high-risk members post-discharge.
• Reassesses needs using the Coleman Care Transition model after discharge.
• Educates members on medication management, follow-up care, and self-care milestones.
• Uses Molina guidelines and CTI to educate, support and motivate change.
• Identifies barriers to care and assists members to address concerns.
• Facilitates interdisciplinary care team meetings and coordination.

Skills

Registered Nurse license

CTI knowledge

Discharge planning

Community resources

Driver's license

Time management

Communication

Self-motivated

MS Office

Tools

Microsoft Office

Job description

Molina Healthcare in Aurora, IL seeks a Registered Nurse to support care transition activities from hospital admission through post-discharge settings. The role focuses on reducing readmissions, coordinating with discharge planners, hospitalists, and care teams to ensure timely, safe transitions.

The ideal candidate has 2+ years in healthcare with discharge planning experience, an active RN license, and a valid driver's license.