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Transition Coach

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Springwell, Inc.

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Location:
United States , Waltham or Marlborough

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Contract Type:
Not provided

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Salary:

28.21 USD / Hour

Job Description:

Join Springwell in a new and exciting partnership that supports older adults returning to the community after a hospitalization! The Transition Coach provides support to a group of patients who have recently discharged home from the emergency room with the goal of reducing readmissions and increasing self-management skills in the community during the first 30 days of discharge.

Job Responsibility:

  • Provide support to patients recently discharged home from the emergency room with the goal of reducing readmissions and increasing self-management skills
  • Conduct home visits
  • Provide follow up calls to offer additional support services, connect the patient to community resources, and review recommendations from the in-person visit
  • Be an integral part of an interdisciplinary team
  • Ensure effective communication across the team to support a smooth discharge home

Requirements:

  • Bachelor’s Degree preferred, experience may be substituted
  • Excellent verbal and written communication skills
  • Ability to independently organize work and meet deadlines
  • Ability to work with an interdisciplinary team across multiple agencies to effectively prioritize and address referrals
  • Ability to complete thorough assessments and identify appropriate home and community-based services and resources to meet needs
  • Experience with discharge planning, case management, care coordination, and/or providing referrals and resources, preferred
  • A reliable car, current driver’s license and safe driving record is required

Nice to have:

Experience with discharge planning, case management, care coordination, and/or providing referrals and resources

What we offer:
  • 3 weeks of vacation in first year
  • Birthday off
  • 13 paid holidays
  • 3 paid personal days
  • 15 paid sick days per year (can accumulate up to 450hrs/12weeks)
  • Health & dental insurance with employer contribution
  • Life and long-term disability insurance at no cost to employee
  • Flexible Spending Plan
  • Employee Assistance Plan
  • 401K Retirement Savings Plan w/ employer contribution
  • Mileage reimbursement
  • Flexible Work Options available after 6 months for most positions
  • alternate start time between 8:00 and 9:30 a.m., 4-day work week, 4.5-day work week, telecommuting work option, remote work option
  • Employee referral bonuses
  • Free parking
  • Commitment to promoting from within

Additional Information:

Job Posted:
January 19, 2026

Employment Type:
Fulltime
Work Type:
On-site work
Job Link Share:

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