Transitional Care Manager

About the role

The Transitional Care Manager (TCM) will work within the INTEGRITY Home Care + Hospice joint‑venture to support patients and families as they move from hospital or skilled‑nursing settings to home‑based services in the Springfield market. This full‑time, field‑based position involves regular hospital rounding and building strong referral relationships.

Key responsibilities

• Round at hospitals at least three days per week and visit skilled‑nursing and other partner facilities throughout the market.
• Support bedside and case‑management activities, coordinate referrals, and ensure smooth transitions to community‑based services.
• Educate patients, families, and referral sources about available care options and services.
• Maintain accurate documentation, follow‑up consistently with partners, and collaborate with the local INTEGRITY team and other TCMs.

Required profile

• Background in clinical or non‑clinical healthcare roles such as nursing, social work, dietetics, case management, marketing, sales, or liaison work.
• Comfortable working independently in hospitals and other facilities, with strong relationship‑building and communication skills.
• Demonstrated initiative, organization, and dependable follow‑through in a high‑activity, field‑based environment.