The Transitions of Care Nurse is a full-time member of the Community Volunteers in Medicine (CVIM) clinical team. This position supports CVIM’s Patient Education and Navigation Services (PENS) initiative, which strengthens healthcare partnerships and enhances care coordination for underserved patients. The nurse’s primary responsibility is to facilitate smooth transitions for patients discharged from hospitals, emergency departments, and specialty care—ensuring timely follow-up, medication reconciliation, and access to needed resources. This role also integrates public health principles, promoting preventive care, immunizations, health screenings, and patient education across CVIM’s service areas. Working closely with hospital partners