Transitions of Care / TCM Consultant

Job description

Help a growth-stage healthcare services and technology company turn its post-discharge service line into a repeatable operating model that reduces avoidable hospital readmissions. This is a focused consulting engagement working directly with the Chief Clinical Officer and an existing clinical team to assess the current pathway, improve workflows, and leave behind practical protocols, training, and an operating playbook the team can run. Consulting / Contract | Remote, U.S. | 4–6 hours of calls per week during business hours Consulting fees are negotiable based on experience, deliverables, and capacity. Hourly, project-based, and fractional arrangements will be considered. Additional preparation and delivery time, total weekly commitment, and engagement duration will be agreed based on scope. What You’ll Deliver Assess and refine the 30-day transitions-of-care / TCM pathway from discharge notification through in-home or virtual follow-up. Develop practical protocols, escalation rules, documentation standards, and training for NPs, RNs, and MAs. Help operationalize medication reconciliation, PCP follow-up, DME, home health, transportation, and caregiver support to reduce readmission risk. Define outcome reporting and support implementation with clinical, product, and engineering teams. Leave the team with a sustainable operating playbook and clear handoff for ongoing execution. What You Bring Meaningful responsibility for designing, implementing, or materially improving a post-discharge, transitions-of-care, post-acute, or readmission-reduction solution. Experience in a care-delivery vendor, post-acute provider, or risk-bearing care organization. Practical knowledge of readmission prevention workflows, clinical team training, health-plan quality measures, and utilization-focused care delivery. A track record of translating a clinical model into live operations and measurable results. Helpful, Not Required Senior Director, VP, or experienced clinical consultant background. Clinical licensure such as RN, NP, or a comparable credential. Client-facing implementation experience. Familiarity with HEDIS, Stars, PCR, TRC, TCM documentation, ADT, or HIE workflows. Important Scope Notes This is a consulting engagement, not a full-time clinical leadership role. Direct patient care is not the primary scope. A prior from-scratch launch is welcome, but not required; what matters is clear contribution to a working post-discharge model, implementation, improvement, or scale. Scope, timing, capacity, and fees will be discussed during the process. At Urrly, fairness matters. Applications are evaluated against the same job-related requirements, including skills, certifications, and experience. Apply now and get a response within 24 hours.