Transitions of Care Lead RN - Population Health
Listed on 2026-02-01
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Healthcare
Healthcare Nursing
Overview
At Saint Alphonsus Health System, we are looking for people who are living out their calling. We want you to be passionate about coming to work, and challenged to achieve your potential. Living by these virtues, we pride ourselves on exceptional service and the highest quality of care.
We are seeking to hire a Transitions of Care Lead RN for our Population Health Team. As a Transitions of Care Lead RN
, you would coordinate Primary Care-Care Management for Population Health RNs and act as liaison between clinics, internal departments, external care facilities, and payors for care transitions. You would support achievement of quality clinical and cost outcomes by incorporating real-time contacts with physicians, nursing, and ancillary caregivers to facilitate transition planning and medication reconciliation. Also complete transition calls or medication reconciliation per department needs.
You would conduct routine department and system wide education on care transition processes with collaboration of department leadership including orienting new colleagues to department. Adhere to departmental goals, objectives, standards of practice, and policies and procedures. Ensure quality patient care and adheres to regulatory compliance. Supports the mission and goals of SAMG Patient Centered Medical Home (PCMH) through patient advocacy and patient centricity.
Responsibilities- Coordinate Primary Care-Care Management for Population Health RNs and act as liaison between clinics, internal departments, external care facilities, and payors for care transitions.
- Support achievement of quality clinical and cost outcomes by facilitating transition planning and medication reconciliation with real-time contacts among physicians, nursing, and ancillary caregivers.
- Complete transition calls or medication reconciliation per department needs.
- Conduct routine department and system-wide education on care transition processes in collaboration with department leadership, including orienting new colleagues to the department.
- Adhere to departmental goals, objectives, standards of practice, and policies and procedures.
- Ensure quality patient care and regulatory compliance.
- Support the mission and goals of the SAMG Patient Centered Medical Home (PCMH) through patient advocacy and patient centricity.
- Minimum of 5 years of experience in a healthcare setting required.
- Ambulatory clinic or care management experience strongly preferred.
- Bachelor's degree in Nursing preferred.
- Must have an RN license in the state of Idaho issued prior to hire date. Must obtain an RN license in the state of Oregon within 6 months of hire.
When Saint Alphonsus takes care of you, you can take better care of our patients. We foster personal and professional growth and offer opportunities that empower our colleagues to develop their careers. Our belief in work-life balance compliments the natural beauty, diverse landscapes, and outdoor recreation lifestyle that is unique to Idaho and Oregon.
- We offer market-competitive pay, generous PTO, and multiple options for comprehensive benefits that begin on day one.
- Benefits for your future include retirement planning and matching, college savings plans for your family, and multiple life insurance plans that can change as your needs develop.
- We are proud to offer Employee Assistance Programs, tuition reimbursement, and educational opportunities to help you learn and grow.
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Ministry/Facility InformationSaint Alphonsus Health System is a faith-based ministry and not-for-profit health system serving Idaho, Oregon, and northern Nevada communities. The health system boasts 4 hospitals, 609 licensed beds, and 73 clinic locations. Through innovative technologies, compassionate staff, and healing environments, Saint Alphonsus goal is to improve the health and well-being of people by emphasizing care that is patient-centered, physician-led, innovative, and community-based.
- Top 15 Health Systems in the country by IBM Watson Health;
- The region’s most advanced Trauma Center (Level II);
- Commission on Cancer Accredited Program through demonstrating an uncompromising commitment to improving patient survival and quality of life.
Rooted in our Mission and Core Values, we honor the dignity of every person and recognize the unique perspectives, experiences, and talents each colleague brings. By finding common ground and embracing our differences, we grow stronger together and deliver more compassionate, person-centered care. We are an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or any other status protected by federal, state, or local law.
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