• Kaiser Permanente (Salem, OR)
    …management skills. Organizational Competencies: Recognizes the impact of systems on health care delivery. Facilitates coordination of care across all ... The RN participates as a member of the health care team in delivering quality health care ...Functions within interdisciplinary teams in a manner that promotes coordination , mutual respect and timely response to the patients… more
    job goal (12/10/25)
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  • Transitional Care

    Banner Health (Loveland, CO)
    …community services, or home with post-acute service support, as directed by the care coordination team. This position performs follow-up tasks and coordinates ... and obtains appropriate services and benefits as directed by the care coordination team. This may include faxing information, entering referrals or tasking… more
    Banner Health (12/03/25)
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  • RN Case Manager

    Cleveland Clinic (Warrensville Heights, OH)
    …teams across the continuum of care to facilitate and ensure effective transitional care coordination . Essential to this role are the core ... care partner(s) to develop a comprehensive, individualized transitional care plan. + Participate and lead...range of motion, manual and finger dexterity and eye-hand coordination . + Requires standing and walking for extensive periods… more
    Cleveland Clinic (12/10/25)
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  • RN Case Manager

    Cleveland Clinic (Stuart, FL)
    …teams across the continuum of care to facilitate and ensure effective transitional care coordination . Essential to this role are the core ... provide you with the opportunity to assist with the coordination of next level of care for... care partner(s) to develop a comprehensive, individualized transitional care plan. + Participate and lead… more
    Cleveland Clinic (12/09/25)
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  • RN Case Management - All Units

    Cleveland Clinic (Cleveland, OH)
    …teams across the continuum of care to facilitate and ensure effective transitional care coordination . Essential to this role are the core ... care partner(s) to develop a comprehensive, individualized transitional care plan. + Participate and lead...range of motion, manual and finger dexterity and eye-hand coordination . + Requires standing and walking for extensive periods… more
    Cleveland Clinic (11/27/25)
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  • RN - Case Manager

    Cleveland Clinic (Vero Beach, FL)
    …teams across the continuum of care to facilitate and ensure effective transitional care coordination . Essential to this role are the core ... and/or care partner(s) to develop a comprehensive, individualized transitional care plan. + Participate and lead in patient rounding activities, huddles… more
    Cleveland Clinic (12/09/25)
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  • RN Case Manager NE

    Cleveland Clinic (Port Saint Lucie, FL)
    …teams across the continuum of care to facilitate and ensure effective transitional care coordination . Essential to this role are the core ... and/or care partner(s) to develop a comprehensive, individualized transitional care plan. + Participate and lead in patient rounding activities, huddles… more
    Cleveland Clinic (09/27/25)
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  • Social Worker - Primary Care (East 85th…

    Mount Sinai Health System (New York, NY)
    …positioned to take a lead role in the development of MSHP by providing transitional and longitudinal care coordination services. **Qualifications** + NYS ... infrastructure and machinery to support population health initiatives, particularly preventive care , through care coordination , information technology,… more
    Mount Sinai Health System (12/06/25)
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  • Social Worker - Geriatric Ambulatory Care

    Mount Sinai Health System (New York, NY)
    …positioned to take a lead role in the development of MSHP by providing transitional and longitudinal care coordination services. **Qualifications** + NYS ... infrastructure and machinery to support population health initiatives, particularly preventive care , through care coordination , information technology,… more
    Mount Sinai Health System (12/06/25)
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  • RN Transition of Care Coach remote based…

    Molina Healthcare (Spokane, WA)
    Care Coach provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from ... proficient knowledge of MS Suite, organized and analytical thinking. Experience with care coordination and discharge planning highly preferred.. Further details… more
    Molina Healthcare (12/05/25)
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  • LPN Transition of Care Coach field…

    Molina Healthcare (Everett, WA)
    …**Job Summary** Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge ... must have a history of working with providers and members to provide care coordination , find resources, managing care needs, advocating, and assessing needs.… more
    Molina Healthcare (12/03/25)
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  • Telephonic Transition of Care Coach (RN)…

    Molina Healthcare (TX)
    …One Note. Job Summary Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from ... and motivate change during member contacts. * Assesses for barriers to care , provides care coordination and assistance to member to address concerns. *… more
    Molina Healthcare (12/11/25)
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  • Transitional Care Coordinator…

    Hartford HealthCare (Southington, CT)
    …you to become part of Connecticut's most comprehensive healthcare network as a Transitional Care Coordinator. Hartford HealthCare at Home, the largest provider ... case / high risk patients home in collaboration with Care Coordination / hospital team / patient...summary and medication list with patient/caregivers and assuring the transitional care processes are implemented by engaging… more
    Hartford HealthCare (09/16/25)
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  • Transitional Care RN - Case…

    Mohawk Valley Health System (Utica, NY)
    Transitional Care RN - Case Management - Full Time - Days Department: CASE MANAGEMENT Job Summary The RN - Transitional Care Coordinator is responsible ... readmission to ensure a successful transition from the hospital to community. The Transitional Care Coordinator RN is accountable to reduce the challenges that… more
    Mohawk Valley Health System (10/07/25)
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  • Transitional Care Clinical Quality…

    SUNY Upstate Medical University (Syracuse, NY)
    Job Summary: The Transitional Care Clinical Quality Improvement Coordinator leads efforts to adhere to evidence-based care for patients as they move through ... the care continuum. Responsibilities include coordination and management of projects that improve quality and...readmission data, identifies trends, and reports findings to the Transitional Care Committee. This RN works closely… more
    SUNY Upstate Medical University (10/01/25)
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  • Transitional Liaison Licensed Practical…

    Elara Caring (Mentor, OH)
    …auto insurance in accordance with the laws of the state. You will report to the Transitional Care Team Lead. _This is not a comprehensive list of all job_ ... Right Care , at the Right Time, in the Right Place. **Job Description:** ** Transitional Liaison LPN/LVN** At Elara Caring, we care where you are and believe… more
    Elara Caring (11/11/25)
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  • RN Transitional Care Manager, Home…

    BAYADA Home Health Care (Rochester, MN)
    Care is currently seeking an experienced **RN** to fill the position of ** Transitional Care Manager (TCM)** to support our **Minnesota** offices. Care ... home, in collaboration with the client's physician. + Promote effective care coordination with the facility, and communicate clinical status and staffing needs… more
    BAYADA Home Health Care (12/06/25)
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  • Hospice Transitional Care Manager,…

    BAYADA Home Health Care (Philadelphia, PA)
    BAYADA Home Health Care is looking for an RN Transitional Care Manager, who will build and strengthen relationships between referral sources and BAYADA ... criteria. 5. Review and compile all documentation necessary, in coordination with referral sources, to transition care from an acute care setting/ sub-acute … more
    BAYADA Home Health Care (11/13/25)
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  • Transitional Care Mgmt Tech…

    Guthrie (Sayre, PA)
    Summary The Transitional Care Management Tech-CA (TCMT) provides telephonic outreach to patients that have been discharged from a hospital or Skilled Nursing ... living and communicate with other members of the patient's care team to ensure care coordination...available to patient/family when needed. + Collaborates with the Transitional Care Nurses (LPN, RN) as needed… more
    Guthrie (12/09/25)
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  • Nursing Assistant- Transitional Care

    Veterans Affairs, Veterans Health Administration (Milwaukee, WI)
    …Living Center and is a 40-bed unit consisting of two programs, Transitional Care and Comprehensive Integrated Inpatient Rehabilitation Program (CIIRP). ... Transitional Care is a short stay (less than 90 day)...a preceptor to new [NAs] by assisting with the coordination of their orientation and overseeing/assessing their practical experience… more
    Veterans Affairs, Veterans Health Administration (12/07/25)
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