Transitional Care Coach (RN) & Care Coordinator

washingtonhospital; Fremont (CA); On-site; USD 131,000 - 177,000; Full time

Job summary

Washington Hospital in Fremont, CA is seeking a Nurse Coach for the Transitional Care Program. You will coordinate post-discharge care, prevent readmissions, and work with physicians, case managers, and home care teams to ensure seamless patient transitions.

Requirements include California RN license, BS degree, BLS, and experience in health coaching or motivational interviewing. You should be comfortable with home visits and using Microsoft Office or Google Suite; weekend availability is

Qualifications

• RN license required
• Bachelor’s degree or equivalent
• AHA BLS certification required
• Valid driver’s license and access to reliable transportation
• Experience with MS Office and/or Google Suite required
• Willing to work weekends
• Health coaching/motivational interviewing preferred
• Strong communication with patients and families

Responsibilities

• Collaborates with outpatient providers to coordinate transitional needs
• Prioritizes referrals and follow-up activities
• Documents patient care in electronic medical records
• Develops individualized care plans for medication self-management and follow-up
• Conducts home visits and in other ambulatory settings as part of the program
• Provides education on chronic illnesses and device use
• Ensures care coordination through a multidisciplinary team
• Interacts with physicians, patients, and families to arrange post-hospital services
• Ensures compliance with safety and licensing standards

Skills

RN license

Communication skills

Health coaching

Motivational interviewing

MS Office / Google Suite

Education

Bachelor’s degree

Master’s degree in Health Care Administration or Nursing

BLS certification

2–3 years transitional care experience

Tools

Microsoft Office

Google Workspace

Job description

Washington Hospital in Fremont, CA is seeking a Nurse Coach for the Transitional Care Program. You will coordinate post-discharge care, prevent readmissions, and work with physicians, case managers, and home care teams to ensure seamless patient transitions.

Requirements include California RN license, BS degree, BLS, and experience in health coaching or motivational interviewing. You should be comfortable with home visits and using Microsoft Office or Google Suite; weekend availability is