Transitional Care Nurse Practitioner (Remote) id-10174

June 5, 2025

Our respected healthcare client is expanding their dedicated patient care team with a Transitional Care Nurse Practitioner position. The ideal candidate will bring at least 3 years of specialized transitional care experience, ensuring seamless coordination of patient care across different healthcare settings. Current Washington state licensure is required for this role that offers both professional growth and the opportunity to make a meaningful impact on patient outcomes.

Description

Job Summary

The Transitional Care Nurse Practitioner is a skilled and experienced clinical professional with comprehensive knowledge of post-transitional care, acute conditions, and treatments. expertise in providing virtual post-discharge care. The Transitional Care Nurse Practitioner will oversee the virtual care of patients in the 30-day window after discharge from an acute setting (hospital or healthcare facility). The Transitional Care Nurse Practitioner will work to deliver the best post-discharge care for patients possible, while ensuring appropriate patient escalations and communication with referring providers and clinical teams. Must be energized by working in a rapidly growing organization, with the agility and resilience to embrace change and rapid cycles of quality improvement.

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Key Duties and Responsibilities:

Perform initial evaluation and management (E/M) visits that include a comprehensive post-discharge assessment of patients’ medical conditions, medications, functional status, and psychosocial needs. Additional requirements include completing a post-discharge medication reconciliation, providing appropriate disease education, and communicating contingency plans for worsening symptoms.

Perform ongoing patient calls focused on addressing a patient’s acute need or new symptom, diagnosing and managing the patient, and ensuring they receive the appropriate level of care.

Participate in interdisciplinary “Grand Rounds” to discuss patients who are at the highest risk of readmission due to worsening clinical symptoms.

Work with a team of internal care providers, including physicians, other nurse practitioners, registered dietitians, and health coaches.

Serves as a resource for coaches and other healthcare professionals regarding post-discharge care, including medications, wound care, and other relevant topics.

Identifies areas for quality improvement in post-discharge care and implements evidence-based interventions to improve post-discharge outcomes.

Participates in policy development and implementation related to transitional care.

Completes accurate documentation in the patient’s dashboard after each engagement.

Other duties as assigned.

Minimum Qualifications

Active unrestricted licensed in the state of Washington.

Multi-state license highly preferred: DC, FL, LA, MD, OR, TX, and WA

At least 3 years of experience in hospital or post-dischargel setting, with clear understanding of common hospital discharge diagnoses, post-discharge needs, and the medical management required to avoid readmissions required.

Strong team player, with a desire to work in an interdisciplinary team to provide the best care to patients.

Experience working in a virtual care environment a plus.

Bilingual in English/Spanish preferred

Salary and Benefits:

Competitive compensation: $60 to $75 per hour, commensurate with experience

Comprehensive healthcare: Medical, dental, and vision benefits available (minimum hours requirement applies)

Flexible vacation policy allowing you to balance work and personal time

Work Environment:

100% remote position with virtual collaboration

Required: Reliable home internet connectivity

Nature of work: Position involves extended periods of computer screen time

Physical requirements: Frequent sitting, viewing computer screens, talking/listening on phone

Manual dexterity: Employee frequently uses hands to finger, handle, or feel; reach with hands and arms

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