Full-Time

Transitional Care Coordinator

Posted on 9/10/2026

Ennoble Care

Ennoble Care

201-500 employees

Home-based palliative care for elderly

Compensation Overview

$18 - $19/hr

+ Quarterly performance bonus + Mileage reimbursement

No H1B Sponsorship

Cleveland, OH, USA

In Person

On-site five days per week in the Cleveland area; travel between facilities may be required.

Category
Medical, Clinical & Veterinary (1)
Required Skills
Word/Pages/Docs
Electronic Health Records (EHR)
Vital Signs
Care Coordination
Excel/Numbers/Sheets
Microsoft Outlook

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Requirements
  • Legally authorized to work in the United States of America.
  • Hold an active, unrestricted Certified Medical Assistant license in the state of Texas.
  • Have at least one year of patient-facing experience in a long-term care, skilled nursing, or transitional care setting.
  • Communicate proactively in person, by phone, via email, and through Microsoft Teams.
  • Have working knowledge of healthcare terminology and care coordination principles.
  • Have clinical assessment skills and the ability to identify and escalate changes in patient condition.
  • Have experience with electronic medical record systems and clinical documentation.
  • Be proficient with Microsoft 365, including Excel, Outlook, Word, and Teams.
  • Have communication and interpersonal skills, organization, time management, and clinical documentation abilities.
  • Work independently while collaborating with multidisciplinary teams.
  • Work full-time in an on-site role five days per week in the Cleveland, Ohio area, during daytime hours approximately 8:00 a.m. to 5:00 p.m. Eastern Time.
  • Pass a background check.
  • Hold a valid, unencumbered driver's license.
  • Have a reliable personally owned vehicle and current auto insurance, with the ability to provide proof.
Responsibilities
  • Coordinate care for patients residing in skilled nursing and rehabilitation facilities using Ennoble Care's electronic medical record system.
  • Facilitate transitional care management and ensure Housecalls services are initiated immediately after a patient's hospital discharge.
  • Expedite the first provider visit for newly transitioned patients in accordance with established guidelines.
  • Monitor patients, communicate changes in condition to providers, initiate appropriate interventions, and escalate care as clinically indicated, including chronic care management-billable activities.
  • Support care coordination efforts to reduce avoidable emergency department visits and hospital readmissions.
  • Collaborate daily with providers and facility staff to keep care plans current and acted upon.
  • Maintain a consistent daily on-site presence in assigned facilities.
  • Build ongoing relationships with residents and their families to reinforce trust and continuity of care.
  • Collect routine and urgent vital signs as needed.
  • Perform regular patient check-ins to support care plans, follow-ups, and clinical stability.
  • Identify changes in patient condition and communicate concerns to the clinical team.
  • Serve as a liaison among providers, facility staff, residents, families, and the Housecalls team.
  • Provide timely and accurate clinical updates to providers to support informed decision-making.
  • Convert two eligible patients per day to Ennoble Care's Housecalls program.
  • Document patient interactions, assessments, and care coordination activities in the electronic medical record.
  • Perform chart reconciliation between Ennoble Care and facility records.
  • Follow established workflows, documentation standards, and escalation protocols.
  • Support onboarding and training of new Transitional Care Coordinators.
  • Serve as a clinical mentor and resource for newly hired coordinators.
  • Promote best practices in transitional care, communication, and facility-based care coordination.
  • Contribute to team collaboration and partnerships with facility staff.
Desired Qualifications
  • Experience with PointClickCare.

Ennoble Care delivers in-home palliative care for seniors, pairing physician and nurse practitioner visits with 24/7 on-call support. Its services are organized as concierge-style care that includes home visits, physical therapy, occupational therapy, and symptom management tailored to each patient. How it works: a care team visits patients at home for ongoing medical assessments and treatments, coordinates therapies and medications, and provides continuous monitoring. Families can contact an on-call line at any time for medical advice. The company differentiates itself by focusing on home-based, individualized care with a holistic, compassionate approach and easy access to a care team through nonstop support. Its goal is to create a space for living that emphasizes comfort, compassion, and healing for seniors and their families.

Company Size

201-500

Company Stage

N/A

Total Funding

N/A

Headquarters

Hackensack, New Jersey

Founded

2017

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Simplify Jobs

Simplify's Take

What believers are saying

  • Norwest and Partners Group backed Ennoble in April 2026, funding expansion.
  • 2024 mergers with Clare Medical and Resurgia added New Jersey and Georgia density.
  • July 2026 report showed 63% fewer year-two hospitalizations and lower Medicare hospital spend.

What critics are saying

  • A November 2025 email breach exposed patient information, inviting OCR penalties and reputation damage.
  • Home-based care depends on clinician recruitment; Ennoble's multi-state footprint strains operational consistency.
  • A failed CMS value-based contract by 2027 would crush margins and stall expansion.

What makes Ennoble Care unique

  • Proprietary EHR for at-home primary and palliative care differentiates Ennoble from generic hospice providers.
  • Fifteen-state plus Washington, D.C. footprint and 50,000 annual patients create unusual density.
  • July 2026 Quality Report showed 25% fewer year-one hospitalizations versus comparable homebound Medicare patients.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

Health Savings Account/Flexible Spending Account

Unlimited Paid Time Off

Paid Vacation

Paid Sick Leave

Paid Holidays

Hybrid Work Options

401(k) Company Match

Referral Program

Payactiv: pay-on-demand

Growth & Insights and Company News

Headcount

6 month growth

-2%

1 year growth

-4%

2 year growth

4%
Norwest Venture Partners
May 5th, 2026
Shaping the Future of Home-Based Care: Why We're Backing Ennoble Care

We believe deeply in the impact Ennoble Care will make on thousands of lives, and are eager to lean in as the company continues to grow

The Manila Times
Nov 21st, 2024
EMPASSION ACHIEVES $34 MILLION IN SAVINGS IN NOVEL MEDICARE PROGRAM SERVING HIGH NEEDS PATIENTS

Ennoble Care is a provider partner with Empassion in the Northeast region and is one of the highest-performing providers in Empassion's ACO program.

Hospice News
May 21st, 2024
Resurgia Health Solutions Merges with Ennoble Care

Resurgia Health Solutions has completed a merger with the home-based primary care, hospice and palliative care company Ennoble Care. Post-merger,

Hospice News
May 21st, 2024
Resurgia Health Solutions Merges with Ennoble Care

Resurgia Health Solutions merges with Ennoble Care.

PR Newswire
May 20th, 2024
Resurgia Health Solutions And Ennoble Care'S Georgia Housecalls Practice Finalize Combination To Strengthen Healthcare Access In Georgia

ATLANTA, May 20, 2024 /PRNewswire/ -- Resurgia Health Solutions and Ennoble Care have united to strengthen healthcare access in Georgia. With no change in leadership, the merged practice will ensure continuity of care while providing more density, responsiveness, and resources to meet patient needs.The partnership between Resurgia Health Solutions and Ennoble Care is grounded in a shared commitment to delivering the highest quality of care. By focusing on value-based care, the merged practice seeks to enhance patient outcomes and improve the overall healthcare experience for individuals and families throughout Georgia.Under the regional leadership of Kevin Charles and Dr. Mark Bradshaw, Ennoble's Georgia home-based primary care practice will be integrated into Resurgia's regional operations and Ennoble's national operations. Renee Brack, FNP, will work closely with Mr. Charles and Dr