Transitional Care Registered Nurse

JOB DESCRIPTION Job Summary The Transitional Care Registered Nurse plays a crucial role in supporting care transition activities for members after hospital discharge. This position focuses on facilitating a smooth transition from acute care to other settings with the goal of minimizing readmission rates. By providing quality and cost-effective member care, you will contribute to our organization’s mission to promote health and well-being. We are seeking candidates with a valid Registered Nurse license in Massachusetts and experience in managed care or case management, particularly in transitioning care. Previous hospital experience is essential, along with a strong skill set in communication, documentation, and electronic medical record (EMR) systems. We value cultural competence, effective time management, and the ability to work autonomously. Bilingual candidates are highly encouraged to apply to better serve our diverse communities! Work Hours: Monday - Friday, 8:00 am - 5:00 pm EST This is a remote position with field travel in Plymouth, Essex, Norfolk, Suffolk, or Middlesex counties in Massachusetts. Essential Job Duties Provide continuous support for members throughout a 30-day program that begins at hospital admission and continues through their transition to various settings, including nursing facilities or their own homes, aiming to reduce readmissions. Collaborate with hospital discharge planners, hospitalists, outpatient providers, facility staff, and the member’s family or support network to ensure safe transitions. Assess member needs post-discharge and coordinate appropriate medical and medication oversight, functional support, and healthcare services. Conduct face-to-face visits with members in the hospital and follow up with high-risk members post-discharge as necessary. Reassess member needs and utilize care transition models to ensure comprehensive post-discharge support. Educate members on vital areas such as medication management, personal health records, follow-up care, recognizing worsening symptoms, nutrition, and available community-based services. Employ motivational interviewing techniques to inspire members toward positive health behaviors during interactions. Identify barriers to care and assist members in addressing any issues that may arise. Facilitate interdisciplinary care team meetings to foster collaboration aimed at enhancing member care. Provide consultations, recommendations, and education as necessary to non-behavioral healthcare managers. Local travel of 40-50% may be required based on state or contractual requirements. Required Qualifications Minimum of 2 years of healthcare experience, including at least 1 year in hospital discharge planning, care management, or behavioral health. Active and unrestricted Registered Nurse (RN) license in Massachusetts. Valid driver’s license, reliable transportation, and appropriate auto insurance for job-related travel, as required by law. Familiarity with Care Transitions Intervention (CTI) or related models. Experience in discharge planning or home health. Knowledge of community resources and services. Strong attention to detail, proactivity, and the ability to adapt communication styles as needed. Ability to work independently with minimal supervision and maintain self-motivation. Excellent communication skills, both verbal and written, along with proficiency in Microsoft Office and other relevant software. Preferred Qualifications Certification in Transitions of Care or Certified Case Manager (CCM). Experience in hospital discharge planning or home health settings. To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board. Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V. Pay Range: $30.37 - $59.21 / HOURLY Actual compensation may vary based on geographic location, work experience, education, and/or skill level.

Created: 2026-03-17