Transition Of Care Jobs for OPT Students
Transition of Care roles coordinate patient handoffs between hospitals, rehab facilities, and home health settings, making them a natural fit for OPT students with clinical or health administration backgrounds. Your OPT work authorization is accepted by most healthcare systems, and STEM OPT extension may apply if your degree qualifies.
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Get Access To All JobsJOB DESCRIPTION
We are seeking a TX licensed Registered Nurse who lives in the Fort Worth service delivery area near Texas Health Harris Methodist - Fort Worth.
This RN will act as a Transition of Care Coach supporting our TX Medicaid members who have recently been admitted to this hospital. The TOCC will support them to ensure a successful transition from inpatient to discharge to either a nursing facility or back to their home. The position is a combination of phone call outreach and in person meetings with the members while still inpatient. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Preferred candidates will have previous case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus.
TRAVEL in the field to designated hospitals in the local service delivery area to meet with the members. Mileage is reimbursed as part of our benefit package.
Schedule: Monday through Friday 8:00AM to 5:00PM CST (No weekends, no nights, no holidays, no call.)
Job Summary
Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions.
- Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network.
- Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support.
- Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition.
- Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed.
- Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge.
- Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives.
- Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
- Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
- Facilitates interdisciplinary care team meetings (ICT) and collaboration.
- Provides consultation, recommendations and education as appropriate to non-behavioral health care managers.
- 40-50% local travel may be required (based upon state/contractual requirements).
Required Qualifications
- At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience.
- Registered Nurse (RN). License must be active and unrestricted in state of practice.
- Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
- Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model.
- Background in discharge planning and/or home health.
- Demonstrated knowledge of community resources.
- Proactive and detail-oriented.
- Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
- Ability to work independently, with minimal supervision and demonstrate self-motivation.
- Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
- Ability to develop and maintain professional relationships.
- Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
- Excellent problem-solving, and critical-thinking skills.
- Excellent verbal and written communication skills.
- Microsoft Office suite/other applicable software program(s) proficiency.
Preferred Qualifications
- Transitions of care sub-specialty certification and/or Certified Case Manager (CCM).
- Hospital discharge planning or home health experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $26.41 - $51.49 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
JOB DESCRIPTION
We are seeking a TX licensed Registered Nurse who lives in the Fort Worth service delivery area near Texas Health Harris Methodist - Fort Worth.
This RN will act as a Transition of Care Coach supporting our TX Medicaid members who have recently been admitted to this hospital. The TOCC will support them to ensure a successful transition from inpatient to discharge to either a nursing facility or back to their home. The position is a combination of phone call outreach and in person meetings with the members while still inpatient. Excellent computer skills and attention to detail are very important to multitask between systems, talk with members on the phone, and enter accurate contact notes. This is a fast-paced position and productivity is important. Preferred candidates will have previous case management, managed care, or inpatient hospital experience. Experience in a behavioral health setting would be a plus.
TRAVEL in the field to designated hospitals in the local service delivery area to meet with the members. Mileage is reimbursed as part of our benefit package.
Schedule: Monday through Friday 8:00AM to 5:00PM CST (No weekends, no nights, no holidays, no call.)
Job Summary
Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge, and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care.
Essential Job Duties
- Follows member throughout a 30 day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions.
- Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpatient providers, facility staff, and family/support network.
- Ensures member transitions to setting with adequate caregiving and functional support, as well as medical and medication oversight support.
- Works with participating ancillary providers, public agencies or other service providers to make sure necessary services and equipment are in place for safe transition.
- Conducts face-to-face visits of all members while in the hospital and, home visits high-risk members post-discharge as needed.
- Coordinates care and reassesses member needs using the Coleman Care Transition model post-discharge.
- Educates and supports member focusing on seven primary areas (Transition of Care Pillars): medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs and or home and community-based services, and advance directives.
- Uses motivational interviewing and Molina clinical guideposts to educate, support and motivate change during member contacts.
- Assesses for barriers to care, provides care coordination and assistance to member to address concerns.
- Facilitates interdisciplinary care team meetings (ICT) and collaboration.
- Provides consultation, recommendations and education as appropriate to non-behavioral health care managers.
- 40-50% local travel may be required (based upon state/contractual requirements).
Required Qualifications
- At least 2 years experience in health care, with at least 1 year of experience in hospital discharge planning, care management or behavioral health setting, or equivalent combination of relevant education and experience.
- Registered Nurse (RN). License must be active and unrestricted in state of practice.
- Valid and unrestricted driver's license, reliable transportation, and adequate auto insurance for job related travel requirements, unless otherwise required by law.
- Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model.
- Background in discharge planning and/or home health.
- Demonstrated knowledge of community resources.
- Proactive and detail-oriented.
- Ability to work within a variety of settings and adjust style as needed - working with diverse populations, various personalities and personal situations.
- Ability to work independently, with minimal supervision and demonstrate self-motivation.
- Responsive in all forms of communication, and ability to remain calm in high-pressure situations.
- Ability to develop and maintain professional relationships.
- Excellent time-management and prioritization skills, and ability to focus on multiple projects simultaneously and adapt to change.
- Excellent problem-solving, and critical-thinking skills.
- Excellent verbal and written communication skills.
- Microsoft Office suite/other applicable software program(s) proficiency.
Preferred Qualifications
- Transitions of care sub-specialty certification and/or Certified Case Manager (CCM).
- Hospital discharge planning or home health experience.
To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.
Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V
Pay Range: $26.41 - $51.49 / HOURLY
Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.
How to Get Visa Sponsorship in Transition Of Care
Target integrated health systems over small clinics
Large hospital networks and accountable care organizations hire transition of care coordinators at scale and have dedicated HR teams familiar with OPT work authorization. Smaller outpatient clinics often lack the infrastructure to process OPT documentation efficiently.
Clarify your STEM OPT eligibility before applying
Health informatics, public health, and health services administration degrees often qualify for the 24-month STEM OPT extension. Confirming this before interviews gives employers a longer runway and significantly increases your chances of sponsorship consideration afterward.
Highlight care coordination certifications
Credentials like the Certified Case Manager (CCM) or Transitional Care Certified (TCC) demonstrate clinical competency beyond your degree. Employers weighing OPT paperwork concerns are more likely to proceed when candidates bring industry-recognized credentials that reduce onboarding risk.
Address OPT timing early in conversations
Proactively tell recruiters your OPT start date, expiration date, and whether a STEM extension is possible. Healthcare employers appreciate this transparency and it eliminates the awkward back-and-forth that sometimes derails candidacies late in the hiring process.
Focus on outcomes in your application materials
Quantify your impact wherever possible: reduced hospital readmission rates, improved patient follow-up completion, or shortened length of stay. Data-driven results signal clinical effectiveness and shift the conversation from visa logistics to your professional value.
Network through healthcare social work and case management communities
Transition of care roles often live inside case management departments. Connecting with social workers, discharge planners, and care coordinators through professional associations surfaces unadvertised openings and referrals, which carry more weight than cold applications for OPT candidates.
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Get Access To All JobsFrequently Asked Questions
Can F-1 OPT students work as Transition of Care coordinators in the U.S.?
Yes. F-1 students authorized for OPT can work as Transition of Care coordinators without any additional visa sponsorship during the OPT period. Your employer simply needs to verify your EAD card. Most hospital systems and health networks are familiar with OPT and accept it as valid work authorization for clinical coordination roles.
Do Transition of Care jobs qualify for the STEM OPT extension?
It depends on your degree, not the job title itself. If you graduated from a STEM-designated program, such as health informatics, biomedical informatics, or health services research, you may qualify for a 24-month STEM OPT extension. Degrees in nursing, social work, or general public health are less commonly STEM-designated, so confirm your program's CIP code with your DSO before counting on the extension.
What healthcare employers are most likely to hire OPT students for Transition of Care roles?
Integrated health systems, accountable care organizations, and large academic medical centers are the most OPT-friendly employers in this space. They hire transition of care staff at volume, have established HR processes for work authorization, and are often experienced with sponsoring H-1B visas afterward. You can browse currently hiring employers on Migrate Mate, which filters specifically for roles open to OPT candidates.
What happens to my Transition of Care job if my OPT expires before I secure H-1B sponsorship?
If your OPT expires and a STEM extension or H-1B is not yet in place, you lose work authorization and must stop working. To avoid this gap, apply for STEM OPT extension at least 90 days before your EAD expires, and discuss H-1B sponsorship timelines with your employer well before the April lottery registration window. Planning 12 to 18 months ahead is realistic for this pathway.
Is a clinical license required to work in Transition of Care on OPT?
Not always. Many Transition of Care positions are non-clinical care coordination roles that require a degree in health administration, social work, or public health rather than a nursing or clinical license. However, some roles, particularly those embedded in hospital care management units, prefer licensed social workers or registered nurses. Review each job description carefully to confirm the licensure requirement before applying.
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