Transition of Care Nurse in Orange at Prospect Medical Systems

Date Posted: 7/16/2020

Job Snapshot

  • Employee Type:
  • Location:
    600 City Parkway West
  • Job Type:
  • Experience:
    Not Specified
  • Date Posted:
  • Job ID:

Job Description

Transition of Care Nurse

We are hospitals and affiliated medical groups, working closely together for the benefit of every person who comes to us for care. We build comprehensive networks of quality healthcare services that are designed to offer our patients highly coordinated, personalized care and help them live healthier lives. Through collaboration, we strive to provide all of our patients and medical group members with the quality, affordable healthcare they need and deserve.

The Transition of Care Nurse is responsible for facilitating person-centered, safe, efficient, and effective care transitions for all Prospect members following discharge to home setting from a hospital or Skilled Nursing Facility (SNF).

Job Responsibilities/Duties

  • Attends daily inpatient rounds.
  • Performs transition of care assessment using questionnaire / assessments provided
  • Ensures patient / member compliance with keeping PCP and other identified provider follow-up appointments.
  • Performs intensified and frequent outreach to identified 'Red' (high risk for readmission as per job aide)
  • Assess members for possible enrollment to care plus programs as appropriate, including but not limited to Heart Failure Programs.
  • Expedite discharge follow-up appointments to specialist as needed.
  • Works in collaboration with Post Discharge Coordinator to identify and address potential risk for readmission.


Minimum Education: High School Diploma or equivalent.

Minimum Experience: Three to five (3-5) years experience in a Medical Group or Health Plan with strong clinical skills.  Knowledge of MS Word. Knowledge of InterQual.

Req. Certification/Licensure: RN/LPN active unrestricted license.

Employee Value Proposition

Prospect Medical Holdings, Inc., is guided by a diverse and highly experienced leadership core. This group maintains the vision that has made Prospect a needed difference-maker in the lives of so many patients today, and many executives contribute to our continued efforts. As a member of our highly effective team of professionals you will receive:

  • Company 401K
  • Medical, dental, vision insurance
  • Paid time-off
  • Life insurance

Prospect Medical Systems has a zero-tolerance policy regarding the use of drugs and alcohol.  Our Company is committed to maintaining a productive, drug free workplace that keeps employees and patients safe from harm.  For this reason, we require applicants to pass a screening for drug use as a condition of employment.  This includes: alcohol, marijuana, cocaine, opiates and methamphetamines.

How to Apply

To apply for this role, or search our other openings, please visit  and click on a location to begin your journey to a new career with us!

We are an Equal Opportunity/ Affirmative Action Employer and do not discriminate against applicants due to veteran status, disability, race, gender, gender identity, sexual orientation or other protected characteristics. If you need special accommodation for the application process, please contact Human Resources.

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