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Transitional Care Management Jobs in Michigan (NOW HIRING)

MyMichigan Health

Social Worker MSW

West Branch, MI · On-site

... management, health care decision making, illness adjustment, ethical/legal concerns, discharge planning, and transitional care needs, child or elder abuse, domestic violence, competency, financial ...

Corewell Health

RN Care Coordinator

Wayne, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning). Responsible for managing a case load of patients that ...

Corewell Health

RN Care Coordinator

Northville, MI · On-site

Identifies patients that need care management services (i.e. utilization review; care coordination; and/or discharge/transition planning). Responsible for managing a case load of patients that ...

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All JobsTransitional Care Management JobsTransitional Care Management Jobs in Michigan

Transitional Care Management information

See Michigan salary details

$27.5K

$46.1K

$81.1K

How much do transitional care management jobs pay per year?

As of Aug 20, 2026, the average yearly pay for transitional care management in Michigan is $46,085.00, according to ZipRecruiter salary data. Most workers in this role earn between $34,900.00 and $56,200.00 per year, depending on experience, location, and employer.

What is a transitional care management?

A Transitional Care Management (TCM) job involves coordinating care for patients as they transition from a hospital or skilled nursing facility back to their home or community setting. TCM professionals, such as nurses or care coordinators, ensure that patients receive follow-up care, medication management, and necessary support to prevent complications or hospital readmission. They communicate with healthcare providers, educate patients on their conditions, and address any barriers to recovery. The goal of TCM is to improve patient outcomes and enhance the continuity of care during this critical period.

What does a transitional care management professional do?

A Transitional Care Management professional is responsible for coordinating and overseeing a patient's care as they move between different healthcare settings, such as from hospital to home. Daily duties often include assessing patient needs, developing individualized care plans, facilitating communication between healthcare providers and family members, and ensuring all necessary follow-up appointments and medications are in place. They also work to identify and address potential barriers to recovery, such as social or environmental factors, to prevent hospital readmissions. The role involves close collaboration with physicians, nurses, social workers, and community resources to provide comprehensive support throughout the transition process.

What are the key skills and qualifications needed to thrive in transitional care management?

To thrive in Transitional Care Management, you need clinical expertise in patient care coordination, discharge planning, and chronic disease management, usually supported by a healthcare degree such as nursing, social work, or a related field. Familiarity with electronic health records (EHRs), care planning software, and current transitional care guidelines is highly valued, along with certifications like CCM (Certified Case Manager) or TCM (Transitional Care Management) when available. Outstanding organization, problem-solving, and interpersonal communication are essential soft skills for building relationships with patients, families, and multidisciplinary teams. These abilities are crucial for ensuring seamless transitions, reducing readmissions, and improving patient health outcomes during vulnerable periods of care transfer.

What are popular job titles related to Transitional Care Management jobs in Michigan?

For Transitional Care Management jobs in Michigan, the most frequently searched job titles are:

What job categories do people searching Transitional Care Management jobs in Michigan look for?

The top searched job categories for Transitional Care Management jobs in Michigan are:

Transitional Care Management jobs near you
Infographic showing various Transitional Care Management job openings in Michigan as of August 2026, with employment types broken down into 79% Full Time, and 21% Part Time. Highlights an 96% In-person, and 4% Remote job distribution, with an average salary of $46,085 per year, or $22.2 per hour.

Care Manager - Inpatient

Mary Free Bed Rehabilitation Hospital

Grand Rapids, MI • On-site

Full-time

Medical, Dental, Vision, PTO

Re-posted 6 days ago

Job description

Employment Type
Full-time
Days Worked
Monday - Friday
Hours:
40 hrs/week, Salaried/Exempt.
Primary Location
Main Hospital - Grand Rapids, MI
Department Name
Care Management
Other Benefits:
Annual Merit Increases, Health Insurance (Medical, Dental, Vision,) PTO, Holiday Pay, PSLF Eligible, Tuition Reimbursement
Summary
Provides care management services to all patients and families to promote optimal functioning throughout the rehabilitation process. Maintains current with clinical practice through continuing education, research, and program development.
Essential Job Responsibilities
  • Provides care management services to patients and families.
  • Provides an initial psychosocial assessment of patient and family functioning, adjustment to disability, health literacy status and coping skills.
  • Provides education to facilitate adjustment, problem solving, and the development/implementation of an appropriate discharge/transition plan.
  • Communicate with patients and families/supports to promote participation in the development and execution of the plan of care.
  • Acts as an internal case manager and functions as liaison with external case managers, providers and funding sources to maximize patient satisfaction, quality, and cost-effective outcomes.
  • Coordinates highly effective level of care transitions from inpatient to community-based levels of care and services, such as: outpatient rehabilitation, home care, hospice, school, vocational rehabilitation, counseling, etc.
  • Oversees the patient follow up process to insure highly durable outcomes.
  • Documents patient/family status, progress and discharge status through initial evaluation, progress notes, and discharge summaries according to established time standards.
  • Identify and remove barriers to the discharge/transition process by:
  • Identifying complex discharge/transition needs early on in order to assist the patient and family/supports in acquiring resources, such as: non-covered medications, home modifications, non-funded equipment, etc.
  • Ensuring access to all needed follow-up primary care and medications at discharge, which may include assistance in locating funding to reduce the likelihood of re-hospitalization.
  • Educate patients and families/supports on current evidence based practices related to complex /chronic disease management across the continuum of care to reduce the frequency of re-hospitalization.
  • Communicates with rehabilitation team regarding patient and family needs, preferences, resources, funding issues and discharge/transition status in order to integrate the care process and minimize fragmentation in the services.
  • Attends and participates actively in-patient team conferences by representing the needs, preferences and resources of the patient and family/supports. Identify the need for and facilitate family conferences as appropriate to assure the needs and preferences of the patient and family/supports are in unison with the goals and clinical interventions of the rehabilitation team.
  • Functions as a patient advocate and maintains patient confidentiality. Educate the patient, the family/supports, and members of the health care delivery team about treatment options, community resources, insurance benefits, psychosocial concerns, case management, etc., so that timely and informed decisions can be made.
  • Promote patient self-advocacy, choice and self-determination. Educate patients and families/supports in the appropriate use of health care services. Improve quality of care and maintain cost effectiveness on a case-by-case basis.
  • Provides discipline specific coverage within the Mary Free Bed System as requested.
  • Participates in orientation and training of new staff.
  • Supervises student internships as appropriate.
  • Supports program operations as assigned.
  • Leadership Must-Haves will be followed for patient and staff interactions:

Customer Service Responsibilities
Demonstrate excellent customer service and standards of behaviors as well as encourages, coaches, and monitors the same in team members. This individual should consistently promote teamwork and direct communication with co-workers and deal discretely and sensitively with confidential information.
Responsibilities in Quality Improvement
Contribute by identifying problems and seeking solutions. Promote patient/family satisfaction where possible; participates in departmental efforts to monitor and report customer service.
Essential Job Qualifications
  • Possesses and demonstrates competence in an identified area of clinical expertise.
  • Registered Nurse, Social Work or in Counseling from accredited school, Master's preferred, not required.
  • Equivalent degrees are accepted provided they are granted from an accredited school
  • Current professional license with the State of Michigan in the area of practice is required
  • Three years of experience as a care manager in a health care setting.
  • Health care experience preferred.
  • Excellent verbal and written communication skills, expressing self in a clear, concise, and professional manner.
  • Ability to work collaboratively and effectively with the interdisciplinary team members and family.
  • Excellent time management and organizational skills. Function in a self-directed manner. Ability to make quality, collaborative decisions in short timeframes.
  • Analytical and strong problem-solving skills. Ability to work effectively and efficiently under tight deadlines, high volumes and multiple interruptions.

Preferred Job Qualifications
  • Experience in interdisciplinary team management.

Physical Requirements:
  • Able to exert up to 10-20 pounds of force occasionally (up to 1/3 of the time)
  • Able to lift, carry, push, pull, up to 10-20 pounds occasionally
  • Able to sit for the majority of the time but may involve brief periods of time involving walking or standing.
  • Able to use keyboard frequently (1/3 to 2/3 of the time)

Consistent with the Americans with Disabilities Act (ADA), it is the policy of Mary Free Bed Rehabilitation Hospital to provide reasonable accommodation when requested by a qualified applicant or employee with a disability, unless such accommodation would cause an undue hardship. The policy regarding requests for reasonable accommodation applies to all aspects of employment, including the application process. If reasonable accommodation is needed, please contact the Talent Acquisition team at recruitment@maryfreebed.com.
The above statements are intended to describe the general nature and level of work being performed by employees in this classification. If you require a reasonable accommodation to perform the essential functions of this position, you must request accommodation in writing, within 182 days after you know or should know of the need for accommodation.
Mary Free Bed is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, national origin, age, genetic information, veteran status, disability or other legally protected characteristic.

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