RN Care Management Transition Coordinator - Winter Garden

An RN Care Management Transition Coordinator role at AdventHealth Winter Garden in Winter Garden, Florida, focused on reducing hospital readmissions through coordinated transitions of care. ### What you'll do - Identify patients with moderate-to-high readmission risk and collaborate with the treatment team to ensure safe transitions of care - Assess patients and families on disease self-management, medication adherence, and compliance — both during admission and for 30–90 days post-discharge - Arrange post-acute resources and coordinate with home health, pharmacy, social work, and care management as a readmission prevention liaison - Collaborate with the multidisciplinary team, present at readmission prevention meetings, and report on readmission trends for the campus - Partner with ED case management to assess potential readmissions and coordinate care to avoid unnecessary returns - Pull and analyze readmission reports to identify patterns and support PAC providers in reducing readmission scores ### What we're looking for - Active Florida RN license (required); BLS certification preferred - Associate's Degree in Nursing required; BSN or MSN preferred - Minimum 1 year of nursing experience; 2+ years in care management, chronic disease management, or care coordination required - Knowledge of chronic disease management and patient advocacy in complex healthcare systems - Strong time management, independent problem-solving, and communication skills - ACM or CCM certification preferred; Cerner proficiency a plus ### What's included - Hourly pay range: $31.55–$58.69 (approximately $65,624–$122,075 annualized) - Medical, dental, vision, life, and disability insurance from day one - Paid time off from day one and 4 weeks of 100% paid parental leave - 403(b) retirement plan - Career development resources and whole-person well-being support ### About the practice AdventHealth Winter Garden is part of AdventHealth, a faith-based, not-for-profit health system operating more than 50 hospitals across the United States. The Winter Garden campus serves a growing community in Orange County, Florida, with a multidisciplinary team approach to inpatient and transitional care. The care management program is structured around readmission prevention and patient empowerment across the continuum of care.