Job Posting

Transitional Care Coordinator/Discharge Planner (Exempt)
City, State: John Day, Oregon

Let the adventure begin in Northeastern Oregon surrounded by beautiful mountain ranges, rural ranching community and lots of outdoor activities.

BLUE MOUNTAIN HOSPTIAL DISTRICT is accepting applications for TRANSITIONAL CARE COORDINATOR/DISCHARGE PLANNER. Competitive wage and benefits package.


The TRANSITIONAL CARE COORDINATOR (TCC), along with the Medical Director, provides Transitional Care Program leadership including implementation, care coordination, marketing and quality assessment. The TCC is knowledgeable of program components, ensures staff are fully trained, provides program and clinical leadership, oversees and coordinates patient-care from pre-admission through discharge, and is actively involved in all program and quality measures.

The DISCHARGE PLANNER will plan, organize and evaluate the discharge planning function of the hospital Works with members of the healthcare team to assure a collaborative approach is maintained in care and treatment of the patient. The Discharge Planner maintains performance improvement activities for the Transitional Care Unit and discharge planning and reports activities to the performance improvement committee of the hospital.

Knowledgeable of the Transitional Care Program process and clinical and CMS guidelines.
Monitors the program quality measures and supports the development of action plans as needed to improve program processes and outcomes.
Participates in marketing and referral development activities.
Identifies and develops new product lines to meet the needs of the community served.
Develops strong relationships with the other acute care hospital discharge planning staff within the referral area.
Is recognized by the care team, administration and patients and families as essential leaders.
Ensures the clinical staff complete education and training and are competent in program clinical skills.
Assess appropriateness of all referrals, engages and educates patient and family on expected discharge plan.
Ensures the Transitional Care program components are in place and functioning properly.
Ensures the collection pertinent quality metrics into the quality reporting portal.
Communicates with family member and caretakers regarding the needs of the patient and anticipated plans including community resources.
Discharge planning goals are established in coordination with the patient and family/caretaker
Maintains current knowledge of resources available within the community, maintains supply of resource materials to be distributed to patients when needed.
Follows through on all patient referrals to agencies or other medical facilities.
Accurately determines type of assistance/setting/resources necessary for the patient/family and provides appropriate resources/assistance/list of facilities.

Establish & maintain solid work relationships through communication, cooperation, and positive interaction with all employees, staff, patients and physicians.



Registered Nurse (RN), MSW or LCSW
1-3 years of Medical Surgical Experience in a hospital

BSN preferred and attained prior to 2020
Management experience preferred


Required: RN License, in good standing with State of Oregon

Preferred: BLS Certification

SUPERVISED BY: Reports to the Nurse Manager

Able to communicate effectively in English, both verbally and in writing.
Additional languages preferred.

This job description reflects managements' assignment of essential functions; it does not prescribe the tasks that may be assigned.

Additional Information
Position Type : Full Time

Contact Information
Recruitment Support - General Inquiries Only
Human Resources
170 Ford Street
John Day, OR 97845
Phone: 541-575-1311 #2964
Transitional Care Coordinator, Discharge Planner, RN, MSW, LCSW, Critical Access Hospital, CAH, Rural Healthcare

Click Here to fill out our official online application.