RN Care Transition Navigator

Molina Healthcare; New Mexico; On-site; USD 36,000 - 70,000; Full time

Job summary

Molina Healthcare in New Mexico seeks a Transition of Care Coordinator (RN) to support member discharge from hospital and coordinate care across settings, aiming to reduce readmissions. The role requires travel to Albuquerque or Las Cruces and collaboration with hospital staff, families, and providers.

Responsibilities include face-to-face visits, post-discharge care coordination, and guiding care teams using CTI principles.

Qualifications

• 2+ years in health care with at least 1 year in discharge planning or care management.
• Active RN license in the state of practice.
• Valid driver’s license and reliable transportation.
• Knowledge of Care Transitions Intervention (CTI).
• Experience in discharge planning and/or home health.
• Ability to work independently and manage multiple projects.

Responsibilities

• Support care transitions from hospital to other settings to reduce readmissions.
• Collaborate with discharge planners, hospitalists, providers and families.
• 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.
• Lead ICT meetings and provide education to care managers.
• Travel 40–50% locally as required by state/contractual requirements.

Skills

Care coordination

Discharge planning

Communication

Time management

Independent work

Interpersonal skills

Travel readiness

Problem solving

Education

RN license

Tools

CTI knowledge

Microsoft Office

Job description

Molina Healthcare in New Mexico seeks a Transition of Care Coordinator (RN) to support member discharge from hospital and coordinate care across settings, aiming to reduce readmissions. The role requires travel to Albuquerque or Las Cruces and collaboration with hospital staff, families, and providers.

Responsibilities include face-to-face visits, post-discharge care coordination, and guiding care teams using CTI principles.