RN Complex Care Coordinator — Discharges & Transitions

LiveWell Homecare Agency, LLC; Austell (GA); On-site; USD 70,000 - 90,000; Full time

Job summary

LiveWell Homecare Agency, LLC is seeking an RN Complex Care Coordinator to assess high-risk patients, plan safe discharges, and coordinate across the care continuum. Acute care experience preferred. Collaborate with patients, families, and interdisciplinary teams to develop discharge plans, arrange post-acute referrals, and ensure smooth transitions.

Document care plans in the EHR to support continuity. This role requires strong communication, organization, and problem-solving in a fast-paced

Qualifications

• Minimum 3 years healthcare experience in acute care or related settings, with at least 2 years in care coordination.
• Associates or Bachelor’s Nursing degree; RN licensure required (multi-state compact preferred).
• Current BLS certification.
• Excellent communication, assessment, organizational, and problem-solving skills.
• Knowledge of regulations, community resources, and care coordination best practices.
• Ability to work collaboratively, handle stressful situations, and adapt in a fast-paced environment.

Responsibilities

• Conduct comprehensive clinical and psychosocial assessments for high-risk patients.
• Develop and implement individualized discharge plans in collaboration with patients, families, and care teams.
• Coordinate post-acute care referrals and facilitate smooth transitions to appropriate care settings.
• Serve as a resource for complex psychosocial, resource, and end-of-life care needs.
• Partner with interdisciplinary teams, community agencies, and support services to address social determinants of health.
• Mentor and precept new staff and interns, sharing expertise on complex cases.
• Document assessments, interventions, and care plans accurately and timely in electronic health records.
• Support quality improvement initiatives and adhere to organizational policies and standards.

Skills

Clinical assessment

Care coordination

Discharge planning

Communication

Education

Associates or Bachelor’s Nursing degree

Tools

Electronic Health Records

Job description

LiveWell Homecare Agency, LLC is seeking an RN Complex Care Coordinator to assess high-risk patients, plan safe discharges, and coordinate across the care continuum. Acute care experience preferred. Collaborate with patients, families, and interdisciplinary teams to develop discharge plans, arrange post-acute referrals, and ensure smooth transitions.

Document care plans in the EHR to support continuity. This role requires strong communication, organization, and problem-solving in a fast-paced