Post Acute Transition Coordinator

3 days ago

Palm Springs, Florida, United States Palm Beach Accountable Care Organization Full time

Shape the Future of Post-Acute Care Coordination

Are you passionate about improving patient outcomes and ensuring smooth care transitions? Join our Network Development Team as a
Post Acute Transition Coordinator
— a vital role that bridges hospitals, patients, and post-acute providers to deliver seamless, compassionate care during one of the most critical stages of recovery.

As a trusted care connector, you'll coordinate the journey from hospital to home or post-acute care facilities, ensuring each patient receives the support, resources, and follow-up they need to thrive. Your work will help reduce readmissions, strengthen partnerships, and elevate the quality of care across our network.

What You'll Do

  • Coordinate seamless care transitions
    from hospital discharge to skilled nursing, rehab, or home-based services.

  • Develop individualized care plans
    by collaborating with physicians, nurses, social workers, and families.

  • Communicate across settings
    to ensure continuity, timely documentation, and exceptional patient experiences.

  • Monitor progress post-discharge
    and proactively address barriers to care or readmission risks.

  • Promote best practices
    and compliance with all care coordination and regulatory standards.

  • Serve as a trusted advocate
    for patients and families navigating complex healthcare systems.

What You Bring

Minimum Qualifications

  • Bachelor's degree in Nursing, Social Work, Healthcare Administration, or related field

  • 2+ years of experience in care coordination, case management, or discharge planning within a healthcare environment

  • Strong understanding of post-acute care services and patient discharge processes

  • Excellent communication, collaboration, and organizational skills

  • Proficiency with EHR systems and care management software

Preferred Qualifications

  • Registered Nurse (RN) license or Certified Case Manager (CCM) credential

  • Experience supporting diverse or complex patient populations

  • Familiarity with Medicare, Medicaid, and insurance authorization processes

  • Training in motivational interviewing or patient advocacy

  • Advanced certifications in care coordination or transitions of care

Your Strengths

  • Skilled at juggling multiple patient cases while keeping care quality front and center

  • Analytical thinker who can identify risks and implement effective care plans

  • Relationship-builder who fosters trust and cooperation across multidisciplinary teams

  • Confident navigating healthcare regulations and insurance systems

  • Tech-savvy professional with proficiency in MS Office and healthcare data tools (MS Project, Smartsheet, Asana, etc.)

Why You'll Love Working Here

  • Make a measurable impact
    on patients' recovery journeys and long-term well-being

  • Collaborate with mission-driven professionals
    who share your passion for high-quality care

  • Grow your career
    through exposure to diverse healthcare systems and innovative care coordination practices

  • Enjoy flexibility
    across regional roles (Southwest, Central, Northwest) with a supportive leadership team that values balance, integrity, and collaboration

Physical Demands:
This position requires periods of sitting, standing, and working at a computer. Occasional lifting (up to 10 lbs) may be needed.

Equal Opportunity Employer
We celebrate diversity and are committed to creating an inclusive environment for all employees.

Ready to make a difference in how patients experience post-acute care?
Apply today and help redefine what successful care transitions look like.

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