RN Care Transitions Navigator

MetroPlusHealth in New York is seeking a Transitions of Care (TOC) Care Manager to coordinate care as members move across settings—hospitals, EDs, rehab, LTC and home health. You will assess needs, reconcile medications, and plan follow-up to prevent avoidable readmissions.

You will engage members and caregivers, develop individualized plans, communicate with primary care clinicians, and link patients to resources while maintaining timely documentation and compliance with policies.