Bilingual Transitions of Care Provider

To support a growing Transitions of Care program, the full-time Bilingual Transitions of Care Provider (NP or PA) will perform comprehensive post-discharge assessments, manage acute virtual care visits, and collaborate with interdisciplinary teams to enhance patient outcomes remotely. Key responsibilities Conduct thorough post-discharge assessments and medication reconciliations for patients Independently assess and manage new or worsening symptoms in complex patients during virtual urgent-care visits Adjust and reinforce patient care plans across a 30-day window based on evolving clinical needs Required qualifications 5+ years of direct patient care experience managing geriatric populations with complex, chronic conditions Active RN and APRN or Physician Assistant licenses in good standing, with the ability to obtain licensure in required states within 90 days of hire Demonstrated experience in both acute management and longitudinal chronic disease management Availability to work full-time, Monday through Friday, from 8:30 AM to 5:00 PM (CST/MST/PST preferred)