Transitions Of Care Nurse

Upward Health

Alameda, US
Base: $95,000 - $105,000 usd; bonus/equity: not sp...
On-site
Transitions of care nursing
Hospital-based care coordination
Real-time adt alert response
Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care, treating physical, behavioral, and social health needs

Job Summary

  • Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care, treating physical, behavioral, and social health needs.
  • The Transitions of Care Nurse responds to ADT alerts, engages patients during hospitalization, and coordinates seamless transitions across care settings for up to 90 days post-discharge.
  • Key responsibilities include conducting home visits, arranging post-discharge needs, educating patients and caregivers, and documenting all encounters in the EHR in real time.

Matching Summary

Upward Health is an in-home, multidisciplinary medical group providing 24/7 whole-person care, treating physical, behavioral, and social health needs.

Salary

Base: $95,000 - $105,000 USD; Bonus/Equity: Not specified; Benefits: Not specified

Skills & Requirements

Must-have

  • Transitions of Care nursing
  • Hospital-based care coordination
  • Real-time ADT alert response
  • Home safety assessments
  • Patient education
  • Electronic health records proficiency

Nice-to-have

  • Chronic disease management knowledge
  • Behavioral health needs assessment
  • Social health needs assessment
  • Case management certification

Key Requirements

  • Registered nursing license (unrestricted)
  • Experience in care coordination
  • Experience in case management
  • Experience in transitions of care
  • Valid driver’s license
  • Auto insurance

Work Rights

Not specified

Tailored Resume

Cover Letter