RN Transitional Care Coordinator
Listed on 2026-07-27
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Nursing
Healthcare Nursing, RN Nurse, Clinical Nurse Specialist, Nurse Practitioner
RN Transitional Care Coordinator
Responsible for ensuring smooth transitions of care for patients being discharged from the hospital setting. Work with population specific, clinic specific, insurance specific, high-risk, or virtual home program patients to optimize recommendations focusing on reducing hospital readmissions, improving patient outcomes, and enhancing patient satisfaction. In collaboration with the physician, hospital care teams and family/significant others, assess, evaluate, and implement a plan of care for the patient.
Work collaboratively with the Transitional Care Program Leadership team, Transitional Care Social Worker, Case Management staff and other members of the multidisciplinary team to develop a Continuum of Care plan to assure patients have the resources and instructions to carry out the plan safely. Follow up with the patient and the patient support structure to ensure compliance with the medical treatment plans.
Minimum Required Qualifications:
- Associate Degree in nursing
- CA RN license
- AHA BLS
- 3 years' nursing experience
- Recent Epic experience
- Ability to demonstrate a working knowledge of community resources, post-acute care coordination, and case management principles
- Broad general knowledge of nursing and possess the ability to effectively navigate and utilize a computerized medical record system
Preferred Qualifications:
- Bachelors of Science in Nursing (BSN)
- Bilingual in Spanish
- Case Management experience
Length of Assignment: 13 weeks
Shift / Hours Per Week: 7:30a-4p M-F
Systems:
Epic
Start Date:
ASAP
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