About this role
AdventHealth Orlando is hiring a full-time Heart Failure Transition Specialist (RN) to coordinate readmission prevention and post-discharge care for heart failure patients at its flagship campus in Orlando, Florida.
### What you'll do
- Identify patients at moderate-to-high readmission risk and coordinate safe, effective transitions from hospital to post-acute settings across a 30–90 day window.
- Serve as liaison among providers, discharge nurses, home health, pharmacy, social work, and care management to align post-discharge plans.
- Collaborate with ED case managers and the PAC Collaborative leader to assess, triage, and prevent unnecessary readmissions.
- Pull, analyze, and present readmission trend reports at campus readmission prevention meetings.
- Educate patients and families on disease self-management, medication adherence, and available community resources during the hospital stay and after discharge.
- Arrange post-acute resources—home health, skilled nursing, community supports—for patients requiring additional support following hospitalization.
### What we're looking for
- Active Florida Registered Nurse (RN) license — required.
- Bachelor of Science in Nursing (BSN) — required; Master of Nursing — preferred.
- Minimum 1 year of nursing experience — required.
- Minimum 2 years of care management, chronic disease management, or care coordination in a healthcare setting — required.
- Proficiency with electronic medical records, MS Outlook, and Excel.
- Bilingual English/Spanish — preferred; Accredited Case Manager (ACM) certification — preferred.
### What's included
- Hourly pay range: $31.55–$58.69 (annualized ~$65,600–$122,100).
- Medical, dental, vision, life, and disability insurance effective Day One.
- Paid Time Off from Day One; 4 weeks 100% paid parental leave.
- 403(b) retirement plan.
- Career development programs and whole-person well-being resources.
### About the practice
AdventHealth Orlando is a 1,400+ bed quaternary-care hospital and one of the largest faith-based health systems in the country, located on a 70-acre campus at 601 E Rollins St in Orlando. The heart failure service line supports a high-volume inpatient population with a robust multidisciplinary team focused on reducing preventable readmissions and improving long-term outcomes.