• Responsible for managing and coordinating the patient care transitions program. • Ensures the patient's progression through the care continuum in a manner that achieves designed clinical and financial outcomes. • Participates in the system development and implementation of integration of care transitions along the continuum of care. • Works in close collaboration with the multidisciplinary team, in all settings to include ambulatory, post - acute providers and health plans. • Serves as mentor by role modeling a professional practice consistent with organizational goals, customer service, clinical effectiveness, and standards of care. • Responsible for developing and managing the departmental budget, compliance to federal, state and regulatory requirements.