Transitions Care Coach - RN or LPN - PRN

Bluegrass Care Navigators•Hazard, KY

About The Position

The Transitions Care Coach provides individualized education and support to eligible patients across various care settings and environments. The role focuses on building trusting relationships while guiding patients toward improved health outcomes through education, encouragement, resource navigation, care coordination, and ongoing support. The coach collaborates with patients to identify goals, overcome barriers, promote self-management strategies, and support successful transitions of care. The position covers Jackson, Laurel, and Whitley counties and is PRN.

Requirements

  • Graduate of an accredited school of professional nursing as a Registered Nurse.
  • Current, unrestricted Registered Nurse (RN) licensure through the applicable State Board of Nursing.
  • Strong communication, interpersonal, and organizational skills to engage with patients, families, caregivers, and healthcare professionals.
  • Knowledge of medical terminology and healthcare processes.
  • Demonstrated ability in patient education, coaching, and teaching principles.
  • Ability to adapt approaches to diverse patient populations and care environments.
  • Experience identifying problems, managing complex situations, and developing effective solutions.
  • Strong customer service skills and ability to work independently, prioritize responsibilities, and manage an assigned caseload.
  • Ability to exercise sound judgment and discretion and maintain confidentiality in accordance with HIPAA and organizational policies.
  • Ability and willingness to conduct visits in settings including private residences, apartments, mobile homes, nursing facilities, hotels, and condominiums, including locations without elevators.
  • Ability to drive for extended periods without restriction or adverse effects.
  • Excellent written and verbal communication skills and attention to detail.
  • Proficiency with computer systems and electronic documentation platforms; computer access is required for PRN team members, and strong computer skills are required for all team members.
  • Ability to provide and receive constructive feedback professionally.
  • Commitment to compliance with Bluegrass Care Navigators Employee Health, infectious disease prevention, and vaccination policies.
  • Licensed driver with an automobile in good working order and insured according to state minimum requirements.

Nice To Haves

  • One to two years of experience in home health, healthcare, care coordination, or a community-based healthcare organization is preferred.

Responsibilities

  • Provide individualized education and support to eligible patients across care settings and environments.
  • Build trusting relationships with patients and encourage improved health outcomes.
  • Help patients navigate resources and coordinate care.
  • Collaborate with patients to identify goals, overcome barriers, and promote self-management.
  • Provide ongoing support for successful transitions of care.
  • Conduct home visits in a variety of settings.
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