Care Transitions Coordinator

17 hours ago


Lowell, Massachusetts, United States Eliot's Full time
About the Role

Eliot's Behavioral Health Division is seeking a highly skilled Care Transitions Coordinator to join our team. As a key member of our Care Transitions Team, you will play a critical role in promoting hope and empowerment for individuals with psychiatric disabilities.

Responsibilities
  • Promote hope and empowerment through meetings with and support of individuals, empowering them to exercise autonomy in all aspects of life.
  • Assist enrollees with identifying choices and developing skills in self-advocacy.
  • Collaborate with Nurse Care Managers to triage hospital admissions data and formulate assertive follow-up strategies to make contact with hospital treatment teams and enrollees during inpatient admissions.
  • Facilitate collaborative discharge planning process for hospitalized enrollees during admissions through phone and face-to-face communication with enrollees and inpatient treatment teams.
  • Ensure that required post-discharge activities and follow-up appointments with providers are scheduled prior to discharge.
  • Coordinate and ensure timely face-to-face contact with enrollees in the community following inpatient discharge within timeframes dictated by MassHealth contract.
  • Communicate discharge disposition updates to assigned Care Manager throughout enrollee inpatient admissions and consult with and/or directly involve assigned Care Manager in the process, as needed.
  • Ensure that discharge plans incorporate follow-up activities and service referrals that match enrollee needs and preferences to reduce the likelihood of readmission.
  • Model and professional communication and conduct toward inpatient facility and ACO/MCO collaterals to foster and maintain strong working partnerships.
  • Follow each hospitalized enrollee through discharge process until all required follow-up activities are completed.
Requirements
  • Bachelor's degree or master's degree in a human services field.
  • Three years' direct experience in Care Management or Case Management, or certification as a Peer Specialist or Recovery Coach.
  • Ability to work in a fast-paced environment and prioritize multiple tasks and responsibilities.
  • Strong commitment to mental health recovery, substance abuse disorders, care coordination, and wellness.
What We Offer

$50,000 annually with 6% bilingual differential (Spanish). Eliot is committed to identifying and dismantling barriers that prevent people with marginalized racial identities from actualizing their full employment potential, assuming leadership roles, or from fully engaging at all levels in the workplace.



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