Transitions of Care Program Manager, RN

Job Description

Location: Charlotte, NC (Hybrid)

We are seeking a Transitions of Care Program Manager, RN to lead a program that supports patients from hospital discharge through their next appointment and builds a safe, well coordinated recovery at home. This position is a full-time, direct hire opportunity based in Charlotte, NC. The role oversees post discharge outreach, medication reconciliation, and follow-up scheduling across acute, skilled nursing, and home health settings, with onsite time at partner facilities.

This role is well aligned for an RN leader with a strong background in case management or discharge planning who enjoys building programs that make a measurable difference in patient outcomes. The ideal candidate coordinates confidently across hospital, post-acute, and primary care teams, leads outreach staff with clear expectations, and uses readmission data to continually strengthen the program.

Responsibilities:

• Lead the transitions of care program across acute, skilled nursing, and home health settings
• Define the post discharge outreach model, including timing, staffing, and escalation criteria
• Ensure post discharge medication reconciliation is completed and discrepancies are resolved
• Build follow-up scheduling pathways so appointments are confirmed before the patient is discharged
• Risk stratify discharges to focus intensive support on patients with the highest readmission risk
• Coordinate handoff communication between hospital, post-acute, and primary care teams
• Monitor readmission rates by facility, service line, and discharge disposition
• Analyze readmission root causes and refine program interventions based on trends
• Lead the nurses and coordinators who conduct post discharge outreach
• Partner with post-acute facilities on shared performance expectations and reporting
• Connect patients with resources for transportation, food, and caregiver support
• Report program performance and financial impact to leadership

Qualifications:

• Bachelor of Science in Nursing preferred
• Active, unrestricted North Carolina or compact Registered Nurse license required
• Certified Case Manager (CCM) credential preferred
• Minimum of 4 years of case management, discharge planning, or transitions of care experience
• Prior program or team leadership experience
• Experience coordinating care across acute and post-acute settings
• Working knowledge of readmission measurement, risk stratification, and CMS readmission programs
• Familiarity with medication reconciliation standards and post discharge follow-up protocols

Schedule:

• Full-time position
• Hybrid schedule based in Charlotte, NC, with onsite time at partner facilities
• Monday through Friday, standard business hours (Eastern Time)
• 40 hours per week

Salary Range: The salary range for this position is approximately $100,000 – $120,000 annually ($48.08 – $57.69 per hour), based on experience and qualifications.

Interview Process: Selected candidates will participate in a multi-step interview process, including an initial screening with TalentLNX followed by interviews with department leadership.

Equal Opportunity Employer: TalentLNX is committed to equal employment opportunity and a diverse, inclusive workforce. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or veteran status.