transitional care nurse

URBAN HEALTH PLAN, INC.

<div>
 
 Job Description
 
 
 
 
 Position Summary:
 
 
 
 The Bilingual English/Spanish Care Transitions Nurse (RN) is responsible for supporting patients during critical transitions of care, particularly following emergency room visits, hospital discharges, and specialty care episodes. This role ensures timely follow-up, medication reconciliation, care coordination, and patient education to reduce readmissions and prevent gaps in care.
 
 
 The Care Transition Nurse works closely with primary care providers, specialists, care management teams, and community partners to ensure continuity of care and improve health outcomes for high-risk and medically complex patients.
 
 
 This role supports the organization's population health, quality improvement, and value-based care initiatives by facilitating safe transitions and promoting patient engagement in ongoing care.
 
 
 As part of the Virtual Care Center- this role is a fully remote position. Although remote, incumbents are required to engage in in person and Bronx-based service throughout training period, and throughout employment for trainings and meetings when requested. Required schedule included Monday through Friday 9am-6pm shift.
 
 
 
 Minimum Qualifications
 
 
 
 <ul>
 <li>
 Associates or Bachelors in Nursing is required.
 </li>
 <li>
 NYS Licensed Registered Nurse is required.
 </li>
 <li>
 Minimum of 2-5 years of clinical nursing experience is required in ambulatory care, community health, or related setting.
 </li>
 <li>
 Bilingual Spanish/English is required.
 </li>
 <li>
 Strong care coordination and patient communication skills
 </li>
 <li>
 Knowledge of hospital discharge processes and transitional care management
 </li>
 <li>
 Ability to identify clinical and social determinants of health impacting care
 </li>
 <li>
 Proficiency in electronic health records and care documentation
 </li>
 <li>
 Ability to work collaboratively across multidisciplinary teams
 
 
 </li>
 </ul>
 
 Key Duties
 
 
 
 
 Transitional Care Management &amp; Patient Follow-Up
 
 
 
 <ul>
 <li>
 Conduct outreach to patients following hospital or emergency department discharge
 </li>
 <li>
 Complete Transitional Care Management (TCM) workflows in accordance with CMS guidelines
 </li>
 <li>
 Ensure patients receive timely follow-up appointments with primary care providers or specialists
 </li>
 <li>
 Facilitate specialty care coordination by assisting patients in navigating referrals, scheduling appointments, and ensuring appropriate follow-up with specialty providers.
 </li>
 <li>
 Perform medication reconciliation and assess for medication adherence and safety concerns
 </li>
 <li>
 Identify and address barriers to care, including transportation, social needs, and access issues
 </li>
 <li>
 Perform medication reconciliation and assess for medication adherence and safety concerns
 </li>
 <li>
 Identify and address barriers to care, including transportation, social needs, and access issues
 
 
 </li>
 </ul>
 
 Care Coordination &amp; Continuity of Care
 
 
 
 <ul>
 <li>
 Coordinate care between hospital systems, primary care providers, specialists, and community resources.
 </li>
 <li>
 Review discharge summaries and hospital documentation to ensure appropriate follow-up care
 </li>
 <li>
 Facilitate referrals, diagnostic testing, and specialty appointments as needed
 </li>
 <li>
 Support patients in understanding discharge instructions and treatment plans Ensure patients do not fall through gaps in care during transitions
 
 
 </li>
 </ul>
 
 High-Risk Patient Management
 
 
 
 <ul>
 <li>
 Identify high-risk patients based on clinical, social, and utilization risk factors
 </li>
 <li>
 Provide additional monitoring and outreach for patients at risk of readmission
 </li>
 <li>
 Collaborate with care managers, CHWs, behavioral health providers, and social services to address complex patient needs
 
 
 </li>
 </ul>
 
 Patient Education &amp; Engagement
 
 
 
 <ul>
 <li>
 Provide patient-centered education regarding diagnosis, medications, warning signs, and follow-up care
 </li>
 <li>
 Promote patient self-management and adherence to treatment plans
 </li>
 <li>
 Encourage ongoing engagement with primary care services
 </li>
 <li>
 Address health literacy and cultural considerations to improve understanding and compliance
 
 
 </li>
 </ul>
 
 Data Documentation &amp; Reporting
 
 
 
 <ul>
 <li>
 Document patient encounters and care coordination activities in the EHR
 </li>
 <li>
 Track outreach efforts, successful contacts, and follow-up outcomes
 </li>
 <li>
 Support reporting for Transitional Care Management (TCM) billing and quality measures
 </li>
 <li>
 Contribute to organizational reporting related to readmission reduction and care continuity
 
 
 </li>
 </ul>
 
 Quality Improvement &amp; Population Health
 
 
 
 <ul>
 <li>
 Participate in initiatives aimed at reducing avoidable hospitalizations and emergency room utilization
 </li>
 <li>
 Identify patterns or barriers affecting successful transitions of care
 </li>
 <li>
 Collaborate with leadership to improve workflows related to discharge follow-up and care coordination
 </li>
 <li>
 Support quality improvement initiatives related to patient access and care continuity
 
 
 </li>
 </ul>
 
 Collaboration &amp; Team Integration
 
 
 
 <ul>
 <li>
 Work closely with providers, care management teams, call center staff, and telehealth teams to coordinate patient care
 </li>
 <li>
 Communicate patient updates and concerns to primary care teams in a timely manner
 </li>
 <li>
 Participate in multidisciplinary meetings focused on high-risk patient management and care planning
 
 
 </li>
 </ul>
 
 Starting Compensation:
 
 Minimum $86,560 per year; Maximum $98,560 per year contingent on degree and years of nursing experience.
 
 
 
 As a full time associate at Urban Health Plan, you'll enjoy:
 
 
 
 <ul>
 <li>
 Fully funded Health Insurance for you/ 73.5% funded Health Insurance for your family
 </li>
 <li>
 Dental, Vision, and Prescription Coverage
 </li>
 <li>
 401(k) Retirement Savings (including 3% annual employer contribution)
 </li>
 <li>
 Comprehensive time off including paid vacation, personal time, sick time, and paid holidays (including your birthday!)
 </li>
 <li>
 Flex Spending Accounts (Health care, Dependent Care, and Commuter Benefits)
 </li>
 <li>
 Entertainment Discount Programs
 </li>
 <li>
 Employee Assistant Program
 </li>
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 Eligibility to apply for Public Service Loan Forgiveness Program (PSLF)
 </li>
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 Fitness Discounts and Perks through our medical plan.
 </li>
 <li>
 $50,000 term life Insurance
 
 
 </li>
 </ul>
 
 About Urban Health Plan
 
 
 
 At Urban Health Plan (UHP) our mission is to continuously improve the health of communities and the quality of life of the people we serve by providing affordable, comprehensive, quality, primary and specialty health care and by assuring the performance and advancement of innovative best practices. At UHP, our commitment to provide patient-centered, holistic, quality health care, is part of a tradition started by our founder, Dr. Richard Izquierdo, 50 years ago. That tradition continues today by promoting excellence in everything that we do.
 
 
 
 UHP is an equal opportunity employer. M/F/D/V. All qualified applicants will receive consideration for employment without regard to race, color, creed, religion, sex, sexual orientation, gender identity, gender expression, national origin/ancestry, citizenship status, disability, age, marital or family status, and military or veteran status.
 
 
 
 Job Requirements
</div>

Care Transitions Nurse (RN)

Wellstar Health System

<div>How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.
Work Shift
Day (United States of America)
WellStar Kennestone Hospital has an opportunity for a Care Coordinator (RN) - Weekend 
Part Time - Day Shift - Weekend Only (Friday, Saturday, and Sunday Only)
8:30AM to 5:00PM<h2 class="jobSectionHeader">
Job Summary:</h2> 
The Care Coordinator RN (CC RN) is responsible for assessing transitional care needs, coordinating care across the continuum, and engaging with patient and family to assure care needs are met. The CC RN plans effectively to meet the patient's needs, manage the length of stay and promote efficient utilization of resources. Overall, the role integrates and coordinates care facilitation, care progression and transitional care planning functions. 
Specific functions within this role include: 
Psychosocial and functional status assessment, transitional care planning, clinical care progression, facilitate patient/family care conferences, participate in interdisciplinary rounds, and patient/family education 
Collaborates effectively with the utilization review nurse, patient's physicians and the interdisciplinary care team to provide a comprehensive assessment of the patient's medical care needs, psychosocial needs, any social determinants of health needs, goals/outcome attainment and continued care needs 
Assures that the patient is progressing towards their discharge goal and assists to alleviate barriers 
Seeks consultation from appropriate disciplines/departments as required to proactively identify and resolve delays to expedite care and facilitate discharge. 
May have other duties assigned<h2 class="jobSectionHeader">
Core Responsibilities and Essential Functions:</h2><div> 
Assessment 
<ul><li>Based on preliminary screening of patients, initiates assessment of patients chronic disease management needs and psychosocial risk factors and availability of resources to assist upon discharge.</li><li>Partners with the PAS, financial counselor and/or UM nurse to assess insurance and coverage requirements for all payers to ensure adherence to those requirements.</li><li>Collaborates with the patient and family, along with the physician(s) and other members of the care team to fully establish and support both the patients care progression and discharge plans..</li><li>Meets with physicians and care team routinely to collaborate on timely and efficient patient management.</li></ul> 
Disposition Planning 
<ul><li>Manages all aspects of discharge planning for assigned patients.</li><li>Implements discharge planning timely and provides resources in an efficient manner.</li><li>Meets with patient/family to assess needs and develop an individualized discharge plan in collaboration with physicians.</li><li>Identifies and documents barriers for timely disposition.</li><li>Ensures/maintains discharge plan consensus with patient/family, physicians, care teams and payers.</li><li>Responds to referrals for patients post-acute needs from physicians and the care team.</li><li>Participates in Interdisciplinary Rounds with the patients care team to confirm estimated date of discharge and make recommendations for best level of care transition at discharge.</li><li>Initiates/facilitates post-acute referrals through departmental processes for timely transition to the next level of care.</li><li>Refer appropriate cases for social work intervention based on departmental protocol.</li><li>Allows for any cultural or religious beliefs in providing service and continuity of care.</li></ul> 
Care Progression 
<ul><li>Collaborates with physicians and care team to facilitate communication regarding patients care progression to ensure timely and efficient delivery of care.</li><li>Proactively identifies delays/obstacles in diagnostic or treatments within the plan of care which can lead to discharge delays.</li><li>Identities and discusses with physician the medical necessity for inpatient testing that may be more appropriate in the outpatient setting.</li><li>Actively works to resolve barriers to discharge and engages/escalates barriers to discharge to the appropriate leader for efficient resolution</li></ul> 
Documentation 
<ul><li>Initial clinical/psychosocial assessment completed and documented in medical record.</li><li>Ensure all records are up-to-date and documentation is clear and concise.</li><li>Ensure timely and accurate documentation in progress notes of interactions with patient/family, physicians, care team, and community partners as it pertains to the patients discharge plan.</li><li>Accounts for and indicates all services arranged/delivered in electronic medical record.</li><li>Track avoidable days and report trends that lead to undesired outcomes.</li></ul> 
Professional Development and Initiative 
<ul><li>Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.</li><li>Supports department-based goals which contribute to the success of the organization.</li><li>Serves as a preceptor and/or mentor for student interns (if appropriate)</li></ul> 
Performs other duties as assigned 
 
Complies with all Wellstar Health System policies, standards of work, and code of conduct.</div><h2 class="jobSectionHeader">
Required Minimum Education:</h2> 
Associate's Degree in Nursing from an accredited school of nursing with a Georgia RN License Required<h2 class="jobSectionHeader">
Required Minimum License(s) and Certification(s):</h2> 
All certifications are required upon hire unless otherwise stated.<ul><li>
Reg Nurse (Single State) or RN - Multi-state Compact</li><li>
Basic Life Support or BLS - Instructor</li></ul><h2 class="jobSectionHeader">
Additional License(s) and Certification(s):</h2><h2 class="jobSectionHeader">
Required Minimum Experience:</h2> 
Minimum 1 year nursing experience in the acute care setting. Required<h2 class="jobSectionHeader">
Required Minimum Skills:</h2> 
Excellent written and verbal communication skill. 
Must possess maturity, self-confidence, objectivity, and positive attitude. 
Self-directed with the ability to function well under stress, handle change, and function in a fast-paced environment 
Strong assessment, interview, organizational and problem-solving skills. 
Knowledge regarding local, state and federal regulations required. 
Knowledge of community and state-wide resources and programs. 
Ability to work collaboratively with physicians, members of the care team, and the patient/family to assist with progression of care through their transition to the next level of care.
Join us and discover the support to do more meaningful work&mdash;and enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.</div>

Care Coordinator (RN) - Part-Time/Rotating Weekends

University of Southern California

<div>Job ID REQ20174951 Category Keck Medicine of USC</div>
 <div>Provides department support for the Continuum of Care Team to facilitate discharge planning and ensure appropriate throughput of patients. Works with Case Managers, Transitional Care Coordinator, and Social Workers to ensure discharge plans are communicated to patients and families during hospitalization and post discharge to ensure continuity and identify clinical barriers. Enables a positive patient experience through the discharge process and connection to resources as needed.
Essential Duties:<ul><li>
Partners with members of the Continuum of Care team both case managers and social workers (RN Case Manager, SW Case Manager) in an effort to provide patients and family members a smooth, coordinated patient transition from hospital to home and/or the next level of care.</li><li>
Partners with members of the Care Coordination team to ensure appropriate communication occurs at the point of discharge so that the patients&rsquo; transition is smooth. Provides timely post-acute contact and reinforces post discharge instructions as needed under the direction of the Transitional Care Coordinator.</li><li>
Under the direction and supervision of Transitional Care Coordinator, utilizes multiple referral platforms such as Enso care, e-fax and phone calls etc. to review post-acute referrals. Also reviews discharge instructions and discharge summary to understand patients&rsquo; post-acute plan of care and barriers to follow-up. Provides timely follow-up on all referrals.</li><li>
Under the direction and supervision of the Transitional Care Coordinator, participates in post discharge phone calls to patients. Uses scripts and follows the Cipher Health algorithm for communication with discharged patients.</li><li>
Under the direction and supervision of the Transitional Care Coordinator, communicates frequently and directly with clinic physician staff and other post-acute providers as needed for discharged patients with identified needs.</li><li>
Follows established policies and procedures and workflows regarding post discharge phone calls.</li><li>
Communicates the discharge plan, status of plan to members of the Continuum of Careteam, including allied health care team members. Participates in triad huddles and in the provisioning of assignments of the triad team.</li><li>
Contacts post-acute care facilities as directed by the Continuum of Careteam to assess bed availability, submission of referrals, bed-hold days. Utilizes multiple referral platforms such as faxing, Enso care etc. to facilitate referrals.</li><li>
Coordinates all non-clinical aspects of the discharge planning process as assigned (i.e. durable medical equipment, homeless shelters, non-clinical letters, transportation) reporting any psychosocial needs, barriers or challenges to the appropriate Continuum of Careteam member.</li><li>
Communicates frequently and directly with Continuum of Care team members regarding discharge process needs and priorities. Communicates orders received to the appropriate case manager, works with the Triad team for daily assignments and tasks needing to be completed. Hands off tasks and duties not performed.</li><li>
Participates in departmental meetings, including but not limited to staff meetings, daily huddles, triad huddles, and Continuum of Care team meetings, etc.</li><li>
Utilizes tools (i.e. Medicare.gov website, tablets for patient choice, etc.) as needed to provide patients with skilled nursing facilities and/or information on discharge planning resources within 10 miles or as close to the patient&rsquo;s home as possible.</li><li>
Documents appropriately following departmental standards in the electronic Medical Record.</li><li>
Assists with transfer of patients for lateral and/or acute services.</li><li>
Supports the Continuum of Careteam with arranging transportation using Taxi, Ride Share, ambulance etc.</li><li>
Assists with maintaining and updating current resources (i.e. pamphlets and brochures) for services as needed for post acute care for use by care coordination team.</li><li>
Participates and engages in continuous improvement activities, including huddles and process improvement projects.</li><li>
Follow all departmental standard work and guidelines including the Triad Model of Discharge Planning. Support transitions of care.</li><li>
Develops and maintains positive working relationships with outside post-acute facilities and vendors to promote timely discharge/transfer.</li><li>
Thrives in a fast-paced, multi-faceted team environment, working well with the key stakeholders, meeting tight deadlines, and multitasking a variety of assignments.</li><li>
Strives to support and contribute to the success of the Continuum of Care team&rsquo;s outcome metrics, key performance indicators and /or departmental goals and objectives.</li><li>
Represents the department in a positive and professional manner.</li><li>
Floating between assignments and between Keck and Norris hospitals is required for management of department needs. On-call, weekend coverage and rotation to manage the discharge needs of the patients within the organization is expected.</li><li>
Supports the clinical process for transfer from one level of care to another as medically indicated by the patient&rsquo;s needs. Able to apply clinical knowledge to reference InterQual Discharge Screens and clinical stability for discharge/transition to the next appropriate level of care.</li><li>
Completes clinical authorization process for the discharge medications.</li><li>
Performs other duties as requested/assigned by Director.</li></ul>
Required Qualifications:<ul><li>
Req High school or equivalent</li><li>
Req Specialized/technical training Nursing Completion of an accredited vocational nursing program.</li><li>
Req 2 years 2-3 years&rsquo; clinical experience.</li><li>
Req Typing 40-55 WPM. Experience with computer data entry.</li><li>
Req Proficient in Microsoft Office Suite.</li><li>
Req Good organizational skills.</li><li>
Req Strong command of the English language.</li><li>
Req Good customer service skills.</li><li>
Req Ability to multitask and work effectively in a team environment.</li></ul>
Preferred Qualifications:
Required Licenses/Certifications:
<ul><li>Req Licensed Vocational Nurse - LVN (CA DCA)</li><li>
Req Fire Life Safety Training (LA City) If no card upon hire, one must be obtained within 30 days of hire and maintained by renewal before expiration date. (Required within LA City only)</li></ul> 
The hourly rate range for this position is $28.00 - $47.75. When extending an offer of employment, the University of Southern California considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate&rsquo;s work experience, education/training, key skills, internal peer equity, federal, state, and local laws, contractual stipulations, grant funding, as well as external market and organizational considerations.
<div>Job ID REQ20174951 Posted Date 05/08/2026</div></div>

Discharge Planning Coordinator, LVN - Case Management - Per Diem 8 Hour Days (Non-Exempt) (Union)

Brooks Rehabilitation

Position Summary : Oversees and provides primary care services to clients at an identified higher risk for rehospitalization by utilizing specific patient and family evidence-based interventions found in research validated care transition models. Leads a cohesive team in delivering at home clinical support and guidance to avoid adverse events. Collaborates continuously with other team members including medical staff to ensure care coordination and timely interventions based on assessed changes in status. Job Responsibilities: Practices at the APRN level to ensure delivery of care coordination, including obtaining new medical orders that support clinical and social services according to the individualized patient plan of care Utilizes the Coleman Care Transitions model&rsquo;s four (4) pillars to guide practice, prioritize care delivery, and facilitate self-care with evidence-based interventions. Provides medication reconciliation and medication adherence teaching to identified clients. Sets goals for self (family) management of medications Performs comprehensive assessment to facilitate understanding of the individual personal health record Ensures timely follow up with primary or specialty care provider Educates on red flag warnings and zone tools to avoid emergency department visits and/or rehospitalization Practices with an innovative virtual platform for managing patient alerts allowing for timely and efficient access to the clinical documentation and patient zone status throughout the agency Performs remote visits as needed with patients throughout the agency Serves as a resource to other professionals regarding transitional care needs including but not limited to wound care, disease management, and follow up care. Synthesizes higher level assessment data collected to implement evidence-based interventions to improve patient outcomes within the home health setting. Participates in quality improvement (QI) initiatives, policy development and education to implement best practices in rehospitalization reduction efforts Participates in root cause analysis (RCAs) of high-risk patients with variances to identify contributing or causative factors to improve quality outcomes and reduce rehospitalizations. Focuses on transitional care needs for patients within the 30-day length of stay (LOS) from an inpatient (overnight) care setting. Works in close collaboration with the telehealth nurse to ensure timely follow up with patients identified as having a change in status. Conducts in-home visits as clinically necessary Works in tandem with the provider who is directing the plan of care for the patient Demonstrates the ability to establish quick trust and therapeutic rapport with patients and families to provide effective patient education and influence patient and family self-management of disease processes. Job Qualifications: Autonomous Practice APRN license in the State of Florida Three years&rsquo; experience in primary care, ambulatory care, or post-acute care setting Experience in and strong knowledge of medication management Strong organization and prioritization skills Able to practice with minimal oversight, self-directed Experience preferred with working in a virtual care environment

APRN Home Health Full Time

Methodist Healthcare System

<div><h5 class="jobSectionHeader">Introduction</h5>
Methodist Hospital is committed to investing in the latest technology enabling nurses to work more efficiently. Are you passionate about delivering patient-centered care? Submit your application for Clinical Nurse Coord Clinical Transitional Care position and spend more time at the bedside with the patient.<h5 class="jobSectionHeader">
Benefits</h5>
Methodist Hospital, offers a total rewards package that supports the health, life, career and retirement of our colleagues. The available plans and programs include:<ul><li>
Comprehensive medical coverage that covers many common services at no cost or for a low copay. Plans include prescription drug and behavioral health coverage as well as free telemedicine services and free AirMed medical transportation.</li><li>
Additional options for dental and vision benefits, life and disability coverage, flexible spending accounts, supplemental health protection plans (accident, critical illness, hospital indemnity), auto and home insurance, identity theft protection, legal counseling, long-term care coverage, moving assistance, pet insurance and more.</li><li>
Free counseling services and resources for emotional, physical and financial wellbeing 
</li><li>
401(k) Plan with a 100% match on 3% to 9% of pay (based on years of service) 
</li><li>
Employee Stock Purchase Plan with 10% off HCA Healthcare stock 
</li><li>
Family support through fertility and family building benefits with Progyny and adoption assistance. 
</li><li>
Referral services for child, elder and pet care, home and auto repair, event planning and more 
</li><li>
Consumer discounts through Abenity and Consumer Discounts 
</li><li>
Retirement readiness, rollover assistance services and preferred banking partnerships 
</li><li>
Education assistance (tuition, student loan, certification support, dependent scholarships) 
</li><li>
Colleague recognition program 
</li><li>
Time Away From Work Program (paid time off, paid family leave, long- and short-term disability coverage and leaves of absence) 
</li><li>
Employee Health Assistance Fund that offers free employee-only coverage to full-time and part-time colleagues based on income.</li></ul>
Learn more about Employee Benefits
Note: Eligibility for benefits may vary by location. 
You contribute to our success let us contribute to yours! Whether you choose to focus on bedside care, a leadership or C-suite role, shape business and operational outcomes, or work to deliver clinical excellence behind the scenes in data science, case management or transfer centers. Unlock your potential at Methodist Hospital!<h5 class="jobSectionHeader">
Job Summary and Qualifications</h5>
The Clinical Nurse Coordinator (CNC) ensures and delivers high quality, patient-centered care and coordination of all functions in the unit/department during the designated shift. In collaboration with other members of the management team, the CNC directs, monitors, and evaluates nursing care in accordance with established policies/procedures, serves as a resource person for staff, and models a commitment to the organization&rsquo;s vision/mission/values to support an unparalleled patient experience and clinical outcomes that contribute to overall departmental performance.
What you will do in this role:<ul><li>
Assists with admission and discharge processes to ensure efficient throughput and high quality, patient-centered care.</li><li>
Participates in the ongoing assessment of the quality of patient care services provided in the unit, in collaboration with other members of the management team.</li><li>
Collaborates with subject matter experts and other managers to create an environment of teamwork that supports improved outcomes and service.</li><li>
Supports a patient-first philosophy and engages in service recovery when necessary.</li><li>
Supports the efforts of the facility to improve engagement by operationalizing current nursing strategies, including employee rounding, hourly rounds, and other initiatives.
</li><li>Provides recommendations related to interviewing, selecting, and training new staff. Recommends and implements courses of action, including training and development, conflict resolution, personnel policy compliance, completion of performance evaluations, and/or disciplinary actions to ensure a competitively better organization.</li><li>
Assists with staff scheduling. Manages all practical aspects of staff labor in accordance with patient care needs and established productivity guidelines.</li><li>
Supports proper inventory control and assists with managing supplies and equipment.</li></ul><h6 class="jobSectionHeader"> 
What qualifications you will need:</h6> 
<ul><li>
Advanced Cardiac Life Spt must be obtained within 90 days of employment start date</li><li>
Basic Cardiac Life Support must be obtained within 30 days of employment start date</li><li>
(RN) Registered Nurse</li><li>
Registered Nurse Diploma, or Associate Degree, or Masters Degree, or Bachelors Degree</li></ul>
Methodist Hospital opened in 1963 as the first hospital in the now internationally acclaimed South Texas Medical Center. With over 900 beds, Methodist Hospital offers a broad range of specialties including cardiology, oncology, bone marrow transplants, emergency medicine, neurosciences, maternity care, gynecology and orthopedics. We are proud to be the largest provider of the lifesaving ECMO Program in San Antonio, are home to the largest robotics program in the world, and our Adult Blood Cancer and Stem Cell Transplant unit has become the first program to receive FACT Accreditation in North America.
As the flagship hospital, and most comprehensive medical care facility of Methodist Healthcare, we appreciate the support and recognition we receive from the community. We&rsquo;ve recently been named the No.1 Best Regional Hospital by the U.S. News and World Report for 2019-20. We pride ourselves on providing the highest quality of care possible for our patients, which is proven by our consecutive Grade A Leapfrog Hospital Safety scores. In addition, Methodist Hospital not only received a Primary Stroke Center designation from The Joint Commission, but has also received a Comprehensive Stroke Center Certification from DNV GL Healthcare, designating the facility as offering the most advanced stroke treatment available in a given geographic area. For more information, please visit our website at www.sahealth.com and select Methodist Hospital under Locations. 
 
Join a family that cares about every stage in your career! We are interviewing candidates for our Clinical Nurse Coord Clinical Transitional Care opening. Apply today and a member of our Talent Acquisition team will reach out.
We are an equal opportunity employer. We do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.</div>

Clinical Nurse Coordinator Transitional Care Unit

Tampa General Hospital

<div><div>Clinical Nurse - Admission Transition Unit 1F - (260001H9)<div>
</div></div><div>
Description<div>
</div><div>
Under general supervision, following established policies, procedures, and professional guidelines, delivers nursing care to patients. Plans and implements nursing care; documents nursing assessments; identifies and reports situations requiring further intervention; formulates and communicates goal-directed plan of care; assures patient rights. Responsible for performing job duties in accordance with the mission, vision and values of Tampa General Hospital and principles of quality improvement.</div><div>
</div></div><div>
Qualifications 
<div></div><ul><li>
Graduate of an accredited School of Nursing.</li><li>
Licensure to practice as a Registered Nurse in the State of Florida.</li></ul><div>
</div></div><div>
Primary Location: Tampa</div><div>
Work Locations: TGH Main Campus 1 Tampa General Circle Tampa 33601</div><div>
Eligible for Remote Work: On Site</div><div>
Job: Nursing (LPNs, RNs)</div><div>
Organization: Florida Health Sciences Center Tampa General Hospital</div><div>
Schedule: Full-time</div><div>
Shift: Night Job</div><div>
Job Type: On Site</div><div>
Shift Hours: 7pm-7am</div><div>
Minimum Salary: 33.32</div><div>
Job Posting: Apr 13, 2026, 2:58:16 PM</div></div>

Clinical Nurse - Admission Transition Unit 1F

Advocate Aurora Health

Part Time Care Transitions Nurse - This is a part-time remote role that requires high-speed internet and requires some evening and weekend coverage. Care Transitions role for both 30 and 90-day programs Medicare/ACO patient population/Medicare FFS program post-hospital discharge.
 
Position Requirements: Bachelor`s Degree in Nursing. Typically requires 2 years of experience in nursing in an acute care or community setting with an emphasis in palliative care or senior services. Excellent written and verbal communication skills. Strong organizational analytical and problem-solving skills. Ability to educate clinical staff and the community. Ability to work well with physicians and other healthcare professionals. Ability to work in a team-based multidisciplinary environment. Registered Nurse license issued by the state in which the team member practices. May need to operate a motorized vehicle to facilitate home visits as appropriate. Must be able to sit stand and walk without restriction. Must have the ability to move about in confined spaces including bending twisting kneeling squatting and occasionally reaching one or both arms overhead. Must be able to concentrate on detailed information, tasks and functions for prolonged periods of time. Must be able to speak clearly and hear in order to communicate in-person or via telephone.
 
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties. Purpose: Responsible for ensuring an efficient and coordinated hospital discharge and transition process for patients recently hospitalized or treated in the emergency room that are at high risk for increased use of healthcare resources. Accountabilities: Identifies the needs of patients and families and coordinates internal and external community resources within the first month of hospital discharge.

Care Transitions Nurse - WEEKENDS

Search 10000+ Transitional care nurse jobs near you this May. New roles added regularly across leading industries. Apply today.