System Manager, Care Transitions

Job Description Summary

The System Manager, Care Transitions plays a pivotal role in leading initiatives that support the organization's transition to value-based care, with a focus on reducing avoidable readmissions and enhancing the patient experience across the care continuum. This position supports the alignment of care transitions operations with MUSC Health’s broader population health and clinical transformation goals.

Entity

Medical University Hospital Authority (MUHA)

Worker Type

Employee

Worker Sub-Type​

Regular

Cost Center

CC004927 SYS - System Case Management

Pay Rate Type

Salary

Pay Grade

Health-31

Scheduled Weekly Hours

40

Work Shift

Job Description

Job Summary/Purpose:  The System Manager, Care Transitions plays a pivotal role in leading initiatives that support the organization's transition to value-based care, with a focus on reducing avoidable readmissions and enhancing the patient experience across the care continuum. This position supports the alignment of care transitions operations with MUSC Health’s broader population health and clinical transformation goals

In this role, the manager is responsible for coaching and supporting a diverse team—including Care Transitions Program Managers, ED Navigators, Medical Scheduling Coordinators, Home Care Coordinators, ED Social Workers and ED Case Managers—to operationalize evidence-based interventions and drive performance in key areas such as the Quintuple Aim, healthcare cost drivers, and value-based care economics.

This individual collaborates with leaders from Case Management, Population Health, Ambulatory ICCE, and the CMOs to ensure that care transitions initiatives are aligned with and embedded within the broader strategic priorities of the health system. In both an advisory and hands-on capacity, the manager helps bridge strategy and operations by turning insights and data into actionable workflows that enhance continuity of care, optimize patient outcomes, and drive overall system performance.

By fostering interprofessional collaboration and building accountability within the team, this leader ensures that patient transitions are well-coordinated, timely, and aligned with quality and performance benchmarks. The role requires strong analytical thinking, a systems perspective, adherence to MUHA standards of behavior, and the ability to lead through influence and change in a complex healthcare environment.

Minimum Training and Education: Master’s degree in Nursing. Minimum of three years of leadership experience in a healthcare or ambulatory care setting. Demonstrated expertise in Care Transitions, Chronic Care Management, Population Health, and Value-Based Care, with a solid understanding of relevant regulations and ethical considerations. Proven ability to lead teams effectively, with strong communication and relationship-building skills. Skilled in managing competing priorities and navigating dynamic, high-paced healthcare environments.

Additional Job Description

Ability to perform job functions while standing. (Continuous) Ability to perform job functions while sitting. (Continuous) Ability to perform job functions while walking. (Continuous) Ability to climb stairs. (Infrequent) Ability to work indoors. (Continuous) Ability to work outside in temperature extremes. (Infrequent) Ability to work from elevated areas. (Frequent) Ability to work in confined/cramped spaces. (Frequent) Ability to perform job functions from kneeling positions. (Infrequent) Ability to bend at the waist. (Continuous) Ability to twist at the waist. (Frequent) Ability to squat and perform job functions. (Frequent) Ability to perform "pinching" operations. (Frequent) Ability to perform gross motor activities with fingers and hands. (Continuous) Ability to perform firm grasping with fingers and hands. (Continuous) Ability to perform fine manipulation with fingers and hands. (Continuous) Ability to reach overhead. (Frequent) Ability to perform repetitive motions with hands/wrists/elbows and shoulders. (Continuous) Ability to fully use both legs. (Continuous) Ability to use lower extremities for balance and coordination. (Frequent) Ability to reach in all directions. (Continuous) Ability to lift and carry 50 lbs. unassisted. (Infrequent) Ability to lift/lower objects 50 lbs. from/to floor from/to 36 inches unassisted. (Infrequent) Ability to lift from 36" to overhead 25 lbs. (Infrequent) Ability to exert up to 50 lbs. of force. (Frequent) Examples include: To transfer a 100 lb. patient that can not assist in the transfer requires 50 lbs. of force. For every 100 additional pounds, assistance will be required from another healthcare worker. 20 lbs. of force is needed to push a 400 lb. patient in a wheelchair on carpet. 25 lbs. of force is required to push a stretcher with a patient with one hand. Ability to maintain 20/40 vision, corrected, in one eye or with both eyes. (Continuous) Ability to see and recognize objects close at hand or at a distance. (Continuous) Ability to match or discriminate between colors. (Continuous) Ability to determine distance/relationship between objects; depth perception. (Continuous) Good peripheral vision capabilities. (Continuous) Ability to maintain hearing acuity, with correction. (Continuous) Ability to perform gross motor functions with frequent fine motor movements. (Continuous) Ability to deal effectively with stressful situations. (Continuous) Ability to work rotating shifts. (Frequent) Ability to work overtime as required. (Frequent) Ability to work in a latex safe environment. (Continuous) Ability to maintain tactile sensory functions. (Continuous) (Selected Positions) *Ability to maintain good olfactory sensory function. (Continuous) *(Selected Positions) *Ability to be qualified physically for respirator use, initially and as required. (Continuous) (Selected Positions)

If you like working with energetic enthusiastic individuals, you will enjoy your career with us!

The Medical University of South Carolina is an Equal Opportunity Employer. MUSC does not discriminate on the basis of race, color, religion or belief, age, sex, national origin, gender identity, sexual orientation, disability, protected veteran status, family or parental status, or any other status protected by state laws and/or federal regulations. All qualified applicants are encouraged to apply and will receive consideration for employment based upon applicable qualifications, merit and business need.

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