RN Transition of Care Navigator – Discharge & Readmission

Molina Healthcare; Sacramento (CA); Remote; USD 85,000 - 110,000; Full time

Job summary

Molina Healthcare is seeking a registered nurse for care transitions and discharge planning to reduce readmissions. The role involves coordinating across hospital, home, and facilities with a focus on safe, cost-effective member care.

Responsibilities include patient visits, caregiver education, and collaboration with interdisciplinary teams to support transition goals and post-discharge outcomes.

Qualifications

• 2 years minimum in health care
• Experience with hospital discharge planning, care management or behavioral health setting preferred
• Knowledge of community resources and resources coordination

Responsibilities

• Facilitate transitional care from hospital to home or other settings
• Coordinate care with discharge planners, hospitalists, providers and family
• Ensure safe transitions with appropriate medical, medication oversight, and support services
• Conduct face-to-face visits during hospitalization and post-discharge
• Educate members on transition of care pillars and follow-up steps
• Coordinate ICT meetings and collaborate with interdisciplinary teams
• Provide consultation on care management to non-behavioral health care managers

Skills

Time management

Prioritization

Independent work

Communication

Education

RN license

CCM certification (preferred)

Tools

Microsoft Office

Job description

Molina Healthcare is seeking a registered nurse for care transitions and discharge planning to reduce readmissions. The role involves coordinating across hospital, home, and facilities with a focus on safe, cost-effective member care.

Responsibilities include patient visits, caregiver education, and collaboration with interdisciplinary teams to support transition goals and post-discharge outcomes.