THPG DISCHARGE NAVIGATOR - Texas Health Southwest _Bring your passion to Texas Health so we are Better + Together_ Position Highlights + Work location: Texas Health Southwest + Work environment: Office + Work hours: Full-time, 40 hours weekly, Monday thru Friday, 8:00am - 5:00 pm Facility: Texas Health Physicians Group (THPG) Texas Health Physicians Group (THPG) is a not-for-profit physician organization with more than 250 locations and 800 physicians, nurse practitioners and physician assistants dedicated to providing quality care in clinics and medical offices throughout North Texas. What You Will Do: Coordinate multidisciplinary discharge planning (pharmacy, social work, case management, primary care, specialty services) to ensure a smooth transition. Work as main facilitator in MDRs. 20% Verify and optimize medication reconciliation and communicate changes clearly to patients and PCPs. 30% Schedule and confirm timely post-discharge follow-up appointments (PCP, specialists, rehab, home health) and provide reminders. 10% Deliver standardized discharge education tailored to literacy and language needs, including red flags and when to seek help. 10% Assess and address social determinants of health that affect discharge (transportation, caregiver support, home safety, financial barriers). 10% Provide patient and family coaching on what to expect after discharge and how to manage transitions of care. 10% Act as a point of contact for patients/families during the first days post-discharge to troubleshoot issues and prevent readmissions. 10% What You Need: Education Bachelor's Degree Nursing from an accredited program RN Req Or Nursing Diploma Accredited school of practical nursing program LVN Req Or Associate's Degree Nursing LVN Req Or Bachelor's Degree Social Work Req Experience 3 Years Hospital Nursing Experience Req Care Transitions Management, Skilled nursing facility and/or home health experience Pref Licenses and Certifications RN - Registered Nurse Completion of RN from an accredited program. Must be licensed in the state of Texas and be in good standing. Upon Hire Req Or LVN - Licensed Vocational Nurse Upon Hire Req Or LCSW - Licensed Clinical Social Worker Upon Hire Req Or LMSW - Licensed Master Social Worker Upon Hire Req And BCLS - Basic Cardiac Life Support Upon Hire Req **Education** Bachelor's Degree Nursing from an accredited program RN Req Or Nursing Diploma Accredited school of practical nursing program LVN Req Or Associate's Degree Nursing LVN Req Or Bachelor's Degree Social Work Req **Experience** 3 Years Hospital Nursing Experience Req Care Transitions Management, Skilled nursing facility and/or home health experience Pref **Licenses and Certifications** RN - Registered Nurse Completion of RN from an accredited program. Must be licensed in the state of Texas and be in good standing. Upon Hire Req Or LVN - Licensed Vocational Nurse Upon Hire Req Or LCSW - Licensed Clinical Social Worker Upon Hire Req Or LMSW - Licensed Master Social Worker Upon Hire Req And BCLS - Basic Cardiac Life Support Upon Hire Req **Skills** Great communication skills Ability to show empathy Practiced in and knowledge of Medicare Advantage and Commercial programs and benefits preferred. Chronic disease management of diverse patient populations and/or experience in health coaching. Excellent time management skills with ability to prioritize tasks effectively and efficiently. **Supervision** Individual Contributor **ADA Requirements** Extreme Heat 1-33% Extreme Cold 1-33% Extreme Swings in Temperature 1-33% Extreme Noise 1-33% Working Outdoors 1-33% Working Indoors 67% or more Mechanical Hazards 1-33% Electrical Hazards 1-33% Explosive Hazards 1-33% Fume/Odor Hazards 1-33% Dust/Mites Hazards 1-33% Chemical Hazards 1-33% Toxic Waste Hazards 1-33% Radiation Hazards 1-33% Wet Hazards 1-33% Heights 1-33% Other Conditions 1-33% **Physical Demands** Sedentary **Travel Requirements** Local 5% May be asked to travel to different hospitals periodically. Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities. We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.