Transitional Care Coordinator

Job Description

Job Description

Transitional Care Coordinator

Los Angeles Area (Remote)

The Transitional Care Management (TCM) Coordinator serves as a pivotal coordinator and subject matter expert for patients transitioning from hospitals, skilled nursing facilities, and other acute settings back into the community. We are looking for empathetic professionals that are enthusiastic about their patient’s health.

Compensation : $25 - $35 / Hour

Benefits : 3 weeks paid time off (2 weeks + 6-7 federal holidays), 401K, Medical, Dental, and Vision.

Responsibilities :

Lead the transitional care process for assigned members from hospital discharge through 30-day post-discharge follow-up, ensuring no lapse in care continuity.

Review clinical documentation, discharge summaries, and hospital notifications to proactively identify follow-up needs, risk factors, and required interventions.

Initiate timely post-discharge outreach (within 24–48 hours) to patients or caregivers to complete medication reconciliation, confirm appointments, and assess home readiness.

Coordinate directly with hospitals, SNFs, home health, PCP offices, and community providers to ensure discharge orders and services are executed appropriately and without delay.

Qualifications :

2 years experience in transitional care (Preferred)

Bilingual (Strongly Preferred)

Bachelor’s degree (Added Plus)