Care Transitions Program Manager

Job Description Summary

The MUSC Care Transitions (CT) Program Manager reports to the System Manager of Care Transitions and works closely with the Population Health, inpatient, and outpatient care teams, as well as the Primary Care and Post-Acute Care teams. This non-leadership role supports departmental, ICCE, and Medical Center objectives, focusing on clinical and quality measures, operational efficiency, and fiscal targets. A key goal is reducing hospital readmissions through patient support services.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC003747 COL - Case Management (DMC)

Pay Rate Type

Salary

Pay Grade

Health-30

Scheduled Weekly Hours

40

Work Shift

Day (United States of America)

Job Description

Job Summary:

The MUSC Care Transitions (CT) Program Manager reports to the System Manager of Care Transitions and works closely with the Population Health, inpatient, and outpatient care teams, as well as the Primary Care and Post-Acute Care teams. This non-leadership role supports departmental, ICCE, and Medical Center objectives, focusing on clinical and quality measures, operational efficiency, and fiscal targets. A key goal is reducing hospital readmissions through patient support services.

The Care Transitions Program Manager coordinates and facilitates activities and services across the patient care continuum, including patient outreach and ongoing care coordination. Collaboration with inpatient and outpatient nursing, case management, social work, physicians, outpatient clinic offices, home health, and other care providers is essential to improve patient outcomes and reduce readmissions.

The Care Transitions Program Manager plays a key role in managing high-risk patients to prevent readmissions and reduce emergency department visits, thereby improving patient quality of life and decreasing healthcare costs related to disease complications and social/environmental factors. The role also emphasizes addressing social determinants of health (SDOH) and ensuring patients receive essential education and support to enhance their health outcomes. This holistic approach aims to improve overall health, reduce hospitalizations, lower morbidity and mortality rates, and optimize the use of inpatient and outpatient resources.

Other duties as assigned.

Requirements (Education, Work Experience, Licensure, Registry &/or Certifications):

Bachelor’s degree in Nursing required. Master’s degree in Nursing preferred. Master’s degree in Social Work required.

Three (3) years of related work experience as a registered nurse or social worker required.

Care Transitions experience preferred.

Proficient in Microsoft Suite Solutions

Must have effective oral, written, and interpersonal communication skills

Ability to Multitask

Current South Carolina licensure or licensure in a compact state as a registered nurse is required for Nurse

applicants.

Current Basic Life Support (BLS), either a certification from an American Heart Association (AHA) BLS for

Healthcare Providers (or AHA recognized equivalent) or an American Red Cross CPR/AED for Professional Rescuer and Healthcare Provider is preferred, but not required.

Physical Requirements:

Ability to perform job functions while standing. (Frequent)

Ability to perform job functions while sitting. (Frequent)

Ability to perform job functions while walking. (Frequent)

Ability to climb stairs. (Infrequent)

Ability to work indoors. (Continuous)

Ability to work outdoors in all weather and temperature extremes. (Infrequent)

Ability to work in confined/cramped spaces. (Infrequent)

Ability to perform job functions from kneeling positions. (Infrequent)

Ability to bend at the waist. (Infrequent)

Ability to squat and perform job functions. (Infrequent)

Ability to perform 'pinching' operations. (Infrequent)

Ability to fully use both hands/arms. (Continuous)

Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Continuous)

Ability to fully use both legs. (Continuous)

Ability to reach in all directions. (Frequent)

Possess good finger dexterity. (Continuous)

Ability to lift and carry 15 lbs. unassisted. (Infrequent)

Ability to lift/lower objects 15 lbs. from/