Molina Healthcare

About the Company

Molina Healthcare is a FORTUNE 500 company that is focused exclusively on government-sponsored health care programs for families and individuals who qualify for government sponsored health care. Molina Healthcare contracts with state governments and serves as a health plan providing a wide range of quality health care services to families and individuals. Molina Healthcare offers health plans in Arizona, California, Florida, Idaho, Illinois, Kentucky, Massachusetts, Michigan, Mississippi, Nevada, New Mexico, New York, Ohio, South Carolina, Texas, Utah, Virginia, Washington and Wisconsin. Molina also offers a Medicare product and has been selected in several states to participate in duals demonstration projects to manage the care for those eligible for both Medicaid and Medicare.

Listed Jobs

Company Name

Molina Healthcare

Job Title

Transition of Care Coach (RN)

Job Description

**Job Title:** Transition of Care Coach (RN) **Role Summary:** Deliver comprehensive transitional care for members from hospital admission through a 30‑day post‑discharge period, coordinating multidisciplinary care and reducing readmissions. **Expactations:** - Oversee member transition from acute setting to all post‑acute settings. - Conduct hospital and home visits; provide follow‑up care coordination. - Travel locally 40‑50% of time as required. - Maintain accurate documentation and communication with all stakeholders. **Key Responsibilities:** - Coordinate transitions with hospital discharge planners, hospitalists, outpatient providers, facility staff, and family/support network. - Ensure safe placement with adequate caregiving, functional support, medication oversight, and equipment. - Utilize the Coleman Care Transition Model and CTI or similar framework. - Educate members on medication management, personal health records, follow‑up care, symptom monitoring, nutrition, functional needs, and advance directives. - Apply motivational interviewing and clinical guideposts to promote behavior change. - Assess barriers to care and facilitate access to ancillary providers and community resources. - Lead interdisciplinary care team meetings and provide consultation to non‑behavioral health managers. **Required Skills:** - Registered Nurse (RN) license active and unrestricted. - Minimum 2 years in healthcare; at least 1 year in discharge planning, care management, or behavioral health. - Knowledge of Care Transitions Intervention (CTI) or comparable model. - Proficiency with Microsoft Office and electronic health record systems. - Strong communication, problem‑solving, critical thinking, and time‑management skills. - Ability to work independently, adapt to diverse populations, and remain calm under pressure. **Required Education & Certifications:** - Active RN license in state of practice. - Preferred: Transitions of Care sub‑specialty certification or Certified Case Manager (CCM).

Spokane, United states

On site

Fresher

02-02-2026