Care Transition Specialist II

3 days ago

Boston, United States Brigham & Women's Hospital(BWH) Full time
Care Transition Specialist II - 40 hour Rotating - BWH CCM Care Coordination

GENERAL SUMMARY/OVERVIEW

The Care Transition Specialist works collaboratively with Care Coordination to complete administrative responsibilities related to care progression and care transitions along the continuum of care.They work collaboratively with nurse care coordinators, social workers, physicians, and other care team members. The Care Transition Specialist is responsible for acting as an advocate for patients and patient families and strives to support Brigham Health's aim for high quality care, high customer satisfaction, and optimal resource management. The person in this position will spend time on the clinical units and have direct interaction with patients and their families, clinical and ancillary hospital staff, and other internal and external customers.

1.Provides direct administrative support to the care team, patients, and patients' caregivers related to continuum of care:

a.Supports the administrative tasks and communication related to post discharge care, including referrals to internal and external resources, such as rehabilitation facilities, home health agencies, hospice, durable medical equipment (DME) providers, and other vendor

b.Actively manages 4Next referrals along the continuum of care, including communication with facilities, agencies, and vendors to promote patient progression to support discharge and effective transitions of care.

c.Secures DME and oxygen for post-acute needs; maps insurance and geography to identify appropriate vendors assesses insurance benefits and coordinates the necessary paperwork with the external vendors and medical team for approval for equipment, such as letters of medical necessity, medical record documentation, and prescriptions. Arranges for and tracks/confirms delivery of equipment prior to or post-discharge.

d.Performs administrative tasks to support the medication prior-authorization function, including completion of forms, securing medical necessity information, and helping to support mitigate barriers for discharge.

e.Assists with the completion of patient follow-up appointments (specialty and PCP) for follow-up care need

f.Secures medical records from outside hospital needed to help determine the Acute treatment plan, including outreach to outside hospitals, completion of forms, securing consent from patient or family and securing outside medical record content

g.Communicates with insurance companies to expedite and/or manage delays with authorization for post-acute care and services or query for covered service

h.Distributes and documents key forms and documents to comply with regulations, including Medicare Important Message and Medicare Outpatient Observation Notice. And prepares and submits Medicare Appeal documentation as needed.

i.Arranges all types of patient transportation under the direction of the care team, including Med Flight, ALS, BLS, Chair Car, Circulation, Care Van or Cab Voucher

j.Submission of longitudinal transport requests, including MassHealth PT-1 and The Ride Applications for patients meeting requirement

k.Participates in family meetings and interdisciplinary huddles to solicit and provide input related to their responsibilitie

l.Accesses and navigates the electronic medical record to obtain essential information, documents progress notes and Resource Specialist Quick Notes as per department standards.

m.Researches and secures out of state and in-network VNAs and facilitie

n.Initiates and/or completes regulatory and other forms, such as MassHealth Long-Term Care and DMH/DDS PASRR forms and processes the completed forms with the appropriate agencies.

o.Completes administrative documentation under the direction of the care team

p.Escalates barriers to discharge

2.Collects, confirms and verifies key patient information (i.e., demographics, health care proxy, benefit verification, and patient preferences for pharmacy, facilities, VNA, etc.).

3.Maintains knowledge and reference materials on key resources available to patients and patients' caregivers across the continuum

a.Acts as a knowledge resource for post-acute care resources, included but not limited to, insurance requirements, facility attributes, contact information, etc.

b.Identifies and refers patients to community services (i.e. transportation, food programs, day programs, and financial programs)

c.Communicates, consults and collaborates with a wide range of agencies and ambulatory practices under thedirection of the care team

d.Private care option

Qualifications

Qualifications:

  1. Associate degree or Bachelor's Degree preferred
  2. Health care experience, preferably in extended care facilities and community agencies, preferred
  3. Preferred experience in hospital discharge planning, long term care facility, community health or utilization review preferred
Skills/Abilities/Competencies Required
  1. Interpersonal skills to interact effectively with various levels of staff, patients, families and community organizations.Must be able to participate effectively in an interdisciplinary team setting.
  2. Extensive knowledge of regulations, community organization, state and federal systems, medical terminology and levels of health care.
  3. Must be able to manage a variable workload with the ability to constantly change priorities.Requires ability to work proactively and independently.
  4. Requires basic typing and/or computer data entry skills, experience with personal computer and software desirable.
  5. Must be very flexible in a constantly changing environment.


Working Conditions

Works in a busy and, at times, stressful hospital/office environment.Must be able to work well independently and in a multi-disciplinary group. Must be flexible.

EEO Statement

Brigham and Women's Hospital is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, sex, color, religion, national origin, sexual orientation, protected veteran status, or on the basis of disability.

  • Care Transition Specialist II

    4 months ago

    Boston, United States Brigham & Women's Hospital(BWH) Full time

    Care Transition Specialist II - 40 hour Rotating - BWH CCM Care Coordination GENERAL SUMMARY/OVERVIEW The Care Transition Specialist works collaboratively with Care Coordination to complete administrative responsibilities related to care progression and care transitions along the continuum of care. They work collaboratively with nurse care coordinators,...

  • Care Transition Specialist II

    1 month ago

    Boston, United States Brigham and Women's Hospital Full time

    Description Care Transition Specialist II - 40 hour Rotating - BWH CCM Care Coordination GENERAL SUMMARY/OVERVIEW The Care Transition Specialist works collaboratively with Care Coordination to complete administrative responsibilities related to care progression and care transitions along the continuum of care. They work collaboratively with nurse care...

  • Critical Care Transition Specialist

    1 week ago

    Boston, Massachusetts, United States TotalMed Full time

    About TotalMedTotalMed is a leading healthcare staffing agency dedicated to providing exceptional nursing services. We offer a wide range of opportunities for travel nurses and allied health professionals.Job Title: Critical Care Transition SpecialistLocation: Boston, MassachusettsEstimated Salary: $97,468 per year (based on 2,375.86/week)About the Role:The...

  • Care Transition Specialist, Lead

    3 days ago

    Boston, United States Brigham and Women's Hospital Full time

    Job Description - Care Transition Specialist, Lead - Post Acute Capacity (3306013) GENERAL SUMMARY/OVERVIEW As a member of the Mass General Brigham - Care Continuum Management team, the Care Transition Specialist Lead will routinely perform Care Transition Specialist duties in addition to completing and supporting with analytical, administrative, and...

  • Care Transition Specialist, Lead

    5 months ago

    Boston, United States Brigham & Women's Hospital(BWH) Full time

    Care Transition Specialist, Lead / 40 hour Rotation - BWH Care Coordination - Post Acute Capacity GENERAL SUMMARY/OVERVIEW As a member of the Mass General Brigham - Care Continuum Management team, the Care Transition Specialist Lead will routinely perform Care Transition Specialist duties in addition to completing and supporting with analytical,...

  • Surgical Specialist II

    4 days ago

    Boston, Massachusetts, United States Tufts Medical Center Full time

    Job SummaryWe are seeking a highly skilled Surgical Specialist II to join our team at Tufts Medical Center. As a key member of the surgical team, you will be responsible for providing exceptional patient care and support during surgical procedures.About the RoleThe Surgical Specialist II will work closely with surgeons, nurses, and other healthcare...

  • Transition of Care Registered Nurse

    3 days ago

    Boston, United States LeadingAge Full time

    Job Location: 415 Columbia Rd - Dorchester, MA Position Type: Full Time 30+ hours Education Level: 2 Year Degree Salary Range: Undisclosed Travel Percentage: None Job Shift: Day Job Category: Health Care Position Title: Transition of Care Registered Nurse Department: Nursing Supervisor: Director of Nursing Hours per week: 40 Primary Function: The Transition...

  • Critical Care Transition Nurse

    1 week ago

    Boston, Massachusetts, United States TotalMed Full time

    Critical Care Transition Nursing OpportunityWe are seeking a skilled Critical Care Transition Nurse to join our team at TotalMed. As a Critical Care Transition Nurse, you will play a vital role in providing specialized care for patients transitioning from critical care to general medical-surgical units.Job OverviewThe ideal candidate will have strong...

  • Critical Care Specialist

    1 week ago

    South Boston, Virginia, United States US Acute Care Solutions Full time

    Are you passionate about delivering exceptional patient care in a fast-paced environment? Do you have what it takes to thrive in a dynamic team as a Critical Care Specialist at US Acute Care Solutions?About the RoleWe are seeking an experienced and skilled Critical Care Specialist to join our team. As a key member of our healthcare team, you will be...

  • Surgical Technologist II

    1 week ago

    Boston, Massachusetts, United States Tufts Medical Center Full time

    Join Tufts Medical Center, a leading integrated health system in Massachusetts, as a Surgical Technologist II - Advanced Perioperative Specialist. We offer a competitive salary and excellent benefits package.About the RoleWe are seeking an experienced and skilled surgical technologist to work in our Operating Room. As a Surgical Technologist II - Advanced...

  • Decentralized Clinical Pharmacist II 7/7

    3 days ago

    Boston, United States Boston Medical Center Full time

    This is an exciting opportunity for a clinical pharmacist to join the Boston Medical Center team with the new expansion of the health system. The Decentralized Clinical Pharmacist II 7/7 is responsible for the provision of direct patient care in different clinical areas (medicine, surgery, critical care, pediatrics). Direct patient care activities include...

  • Transition of Care-Nurse Care Manager, Population Health- Hybrid

    1 week ago

    Boston, United States Partners HealthCare Full time

    Are you a dedicated and experienced nurse with a passion for improving patient care and driving positive health outcomes? The Population Health Management (PHM) department at Mass General Brigham invites you to bring your expertise to a dynamic team committed to innovative care models that enhance patient value across our system. Why Join Mass General...

  • Travel Care Specialist

    4 days ago

    Boston, Massachusetts, United States GLC On-The-Go Full time

    Company OverviewGLC On-The-Go is a trusted partner in the staffing industry, dedicated to connecting healthcare professionals with opportunities that align with their career goals and lifestyle.About Our OpportunityWe are currently seeking a travel care specialist to join our team in Boston, Massachusetts. This is an exciting opportunity for a skilled RN to...

  • Family Care Specialist

    1 week ago

    Boston, Massachusetts, United States Care Full time

    OverviewCare.com is a leading platform for finding and managing high-quality family care, available in more than 20 countries.About the RoleWe are seeking a qualified Family Care Specialist to provide childcare services to multiple families in their homes. As a key member of our team, you will be responsible for creating a safe, nurturing, and stimulating...

  • Nurse Care Specialist

    1 week ago

    Boston, Massachusetts, United States Mass General Brigham Full time

    Job OverviewWe are seeking a skilled Nurse Care Specialist to join our team at Mass General Brigham Healthcare at Home.About the RoleThis is an ongoing, 36 hour per week position with a 12 hour day shift. As a Nurse Care Specialist, you will provide quality clinical services to patients in various settings within the community.ResponsibilitiesDevelop and...

  • Life Science Technical Specialist II

    2 days ago

    Boston, United States Renovo Solutions Full time

    Renovo Solutions is a nationwide healthcare technology management company, owned by a private equity firm, that offers a range of opportunities for technicians to grow within the company. With a presence in 40 states, we provide comprehensive solutions for managing and maintaining healthcare technologies. We prioritize investing in our employees'...

  • Nursing Care Specialists

    4 days ago

    Boston, Massachusetts, United States Bear Mountain Health Care Full time

    Bear Mountain Health Care is committed to delivering exceptional patient care. We are currently seeking Nursing Care Specialists to join our team. In this role, you will work closely with patients, families, and healthcare professionals to provide personalized care.The estimated annual salary for this position is $60,000 - $75,000, based on industry...

  • Cardiac Cath Tech II

    5 days ago

    Boston, United States Brigham & Women's Hospital(BWH) Full time

    The Cardiac Catheterization Technologist II acts as a critical member of the patient care team within the department, collaborates fully with the other care team members in assuring continuity of care for their patients. The Cardiac Catheterization Technologist II promotes a philosophy of patient/family-focused care in all interactions with patients,...

  • Engagement Partner II

    6 months ago

    Boston, United States Bay Cove Human Services Full time

    Engagement Partner II - ACCS Community Boston, MA, USA Req #1883 Thursday, May 30, 2024 Bay Cove Human Services’ mission is to partner with people to overcome challenges and realize personal potential. Bay Cove pursues this mission by providing individualized and compassionate services to people facing the challenges associated with developmental...

  • Administrative Associate II

    1 month ago

    Boston, United States Children's Hospital Boston Full time

    76943BRJob Posting Title:Administrative Associate II - Complex Care ServiceDepartment:Ambulatory ServicesAutoReqId:76943BRStatus:Full-TimeStandard Hours per Week:40 Job Posting Category:AdministrationJob Posting Description: The Division of General Pediatrics strives to provide a high quality of care across the continuum to over 4,000 children with medical...