What are the responsibilities and job description for the Post Acute Care Coordinator position at Palm Beach Accountable Care Organization?
Are you passionate about improving patient outcomes and ensuring smooth care transitions? Join our Network Development Team as a Post Acute Transition Coordinator — a vital role that bridges hospitals, patients, and post-acute providers to deliver seamless, compassionate care during one of the most critical stages of recovery.
As a trusted care connector, you’ll coordinate the journey from hospital to home or post-acute care facilities, ensuring each patient receives the support, resources, and follow-up they need to thrive. Your work will help reduce readmissions, strengthen partnerships, and elevate the quality of care across our network.
What You’ll Do
Coordinate seamless care transitions from hospital discharge to skilled nursing, rehab, or home-based services.
Develop individualized care plans by collaborating with physicians, nurses, social workers, and families.
Communicate across settings to ensure continuity, timely documentation, and exceptional patient experiences.
Monitor progress post-discharge and proactively address barriers to care or readmission risks.
Promote best practices and compliance with all care coordination and regulatory standards.
Serve as a trusted advocate for patients and families navigating complex healthcare systems.
What You Bring
Minimum Qualifications
Bachelor’s degree in Nursing, Social Work, Healthcare Administration, or related field
2 years of experience in care coordination, case management, or discharge planning within a healthcare environment
Strong understanding of post-acute care services and patient discharge processes
Excellent communication, collaboration, and organizational skills
Proficiency with EHR systems and care management software
Preferred Qualifications
Registered Nurse (RN) license or Certified Case Manager (CCM) credential
Experience supporting diverse or complex patient populations
Familiarity with Medicare, Medicaid, and insurance authorization processes
Training in motivational interviewing or patient advocacy
Advanced certifications in care coordination or transitions of care
Your Strengths
Skilled at juggling multiple patient cases while keeping care quality front and center
Analytical thinker who can identify risks and implement effective care plans
Relationship-builder who fosters trust and cooperation across multidisciplinary teams
Confident navigating healthcare regulations and insurance systems
Tech-savvy professional with proficiency in MS Office and healthcare data tools (MS Project, Smartsheet, Asana, etc.)
Why You’ll Love Working Here
Make a measurable impact on patients’ recovery journeys and long-term well-being
Collaborate with mission-driven professionals who share your passion for high-quality care
Grow your career through exposure to diverse healthcare systems and innovative care coordination practices
Enjoy flexibility across regional roles (Southwest, Central, Northwest) with a supportive leadership team that values balance, integrity, and collaboration
Physical Demands:
This position requires periods of sitting, standing, and working at a computer. Occasional lifting (up to 10 lbs) may be needed.
Equal Opportunity Employer
We celebrate diversity and are committed to creating an inclusive environment for all employees.
Ready to make a difference in how patients experience post-acute care?
Apply today and help redefine what successful care transitions look like.
Salary : $55,000 - $65,000