VitalCaring Group logo
Home Healthcare, Hospice Care, Healthcare

Care Transition Navigator - Weekend

San Antonio, TXOnsiteFull TimePosted 2 months ago

Is this role right for you?

Upload your resume and get a skill-by-skill breakdown — see exactly where you match, where you're close, and what to highlight. Not a mystery percentage.

Get a tailored resume highlighting what this role needs.

Required skills

  • RN
  • LVN
  • LPN
  • PT
  • clinical experience
  • healthcare coordination
  • case management
  • clinical care
  • hospital-based roles
  • patient care transitions

Nice to have

  • home health
  • hospice
  • post-acute care
  • hospital systems
  • CMS guidelines
  • readmission reduction strategies

Role summary

VitalCaring, a leading provider of home health and hospice services, seeks a Care Transition Navigator (CTN) to facilitate seamless transitions from hospital to home health care. This field-based role involves partnering with hospital case managers, physicians, patients, and families to coordinate care, reduce readmissions, and improve patient outcomes. Responsibilities include bedside assessments, developing transition plans, driving admissions, and post-discharge follow-up. Requires an active RN, LVN/LPN, or PT license and a minimum of two years of clinical experience, with home health or post-acute experience preferred. Strong understanding of care transitions, case management, and relationship-building skills are essential.

Join VitalCaring – Where Your Passion Changes Lives!

Who We Are

Founded in 2021, VitalCaring has grown into a leading provider of home health and hospice services, with over 100 locations across the country. We are committed to fostering a culture of support, growth, and excellence for our team that is the backbone of how we ensure we deliver exceptional patient care.

What Sets Us Apart?

Meaningful work. A flexible schedule. Benefits that recognize your commitment.

This is a 16-hour-per-week weekend position designed for compassionate professionals who want to make a meaningful difference in the lives of patients and their families while maintaining balance in their own lives.

We value the time, heart, and dedication you bring to home health & hospice care—and we want our benefits to reflect that.

  • 6 paid PTO days per year to rest, recharge, and care for yourself
  • Company-designated holidays are truly yours — no PTO is required to take these days off
  • 401(k) eligibility, subject to applicable plan terms and eligibility requirements
  • Because caring for others starts with making sure you have the support and time you need, too.

    Care Transition Navigator (CTN) – Home Health - Weekend Sat/Sun

    Field-Based | Hospital-Focused | Patient Transition & Care Coordination

    Role Overview

    The Care Transition Navigator plays a critical role in ensuring safe, seamless transitions from the hospital to home health care. This position works directly within assigned hospital systems, partnering with case managers, physicians, patients, and families to coordinate care, reduce readmissions, and improve patient outcomes.

    This is a high-impact, relationship-driven role that blends clinical insight, care coordination, and referral management to support both patient success and agency growth.

    Key Responsibilities

  • Serve as the primary liaison between hospital teams, patients, and VitalCaring clinicians to ensure seamless transitions from hospital to home
  • Conduct bedside assessments to identify clinical needs, risk factors, and barriers to successful discharge
  • Partner with case managers and physicians to develop and execute safe, patient-centered transition plans
  • Drive timely admissions by coordinating referrals and ensuring smooth handoffs into home health services
  • Build strong, trusted relationships with hospital partners through consistent communication and follow-through
  • Complete post-discharge follow-up within 48 hours and ensure timely primary care coordination
  • Collaborate with internal teams and support initiatives focused on improving outcomes and reducing readmissions
  • Required Qualifications

  • Active RN, LVN/LPN, or PT license in the state of employment (or compact eligibility, if applicable)
  • Minimum of two (2) years of clinical experience; home health or post-acute experience preferred
  • Experience in healthcare coordination, case management, clinical care, or hospital-based roles
  • Strong understanding of patient care transitions, discharge planning, or post-acute services
  • Demonstrated ability to build relationships with healthcare providers and interdisciplinary teams
  • Excellent communication skills with the ability to engage patients, families, and clinicians effectively
  • High level of organization with the ability to manage multiple patients and priorities simultaneously
  • Proficiency with EMR systems and basic computer applications
  • Valid driver’s license and reliable transportation
  • Preferred Qualifications

  • Experience in home health, hospice, or post-acute care
  • Background working within hospital systems (case management, discharge planning, or bedside coordination)
  • Knowledge of CMS guidelines and readmission reduction strategies
  • Familiarity with Homecare Homebase (HCHB) or similar EMR systems
  • Work Environment & Expectations

  • Field-based role with regular presence in assigned hospitals and healthcare facilities
  • High-touch, patient-facing position requiring strong interpersonal and clinical communication skills
  • Fast-paced environment requiring adaptability, critical thinking, and proactive follow-through
  • Performance expectations tied to both patient outcomes and successful care transitions/admissions
  • Requires strong time management to balance hospital coordination, patient interaction, and documentation
  • All employment decisions are made without regard to race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or any other protected characteristic. Candidates are evaluated based on job-related qualifications, skills, and business needs.#AppSales

    Ready to apply?
    You'll be redirected to VitalCaring Group's application page.

    Similar roles

    See how RiseMe works

    Match, tailor, and prep so you send fewer applications and land more interviews.