Patient Care Transition Coordinator

2 weeks ago


Ithaca, New York, United States Cayuga Health System Full time

Cayuga Health System, a prominent healthcare provider in the region, is dedicated to enhancing the health and well-being of the communities we serve. Our organization prides itself on fostering a culture of innovation and excellence in healthcare delivery. We offer competitive compensation and a comprehensive benefits package, alongside numerous opportunities for professional growth within the healthcare sector.

As part of our commitment to patient-centered care, we have developed the Community Medicine Program in collaboration with Visiting Nurse Service of Ithaca and Tompkins Counties (VNS).

The **Patient Care Transition Coordinator** plays a vital role in ensuring a seamless transition of care for patients moving from hospital settings to their homes. Reporting to the Manager of Transportation and EMS, this position serves as a crucial link between patients, their primary care providers, and hospital staff, facilitating ongoing recovery and health education.

Key Responsibilities:

  • Facilitate the onboarding process for new patients entering the Community Medicine Program, led by VNS.
    • Conduct hospital visits to educate patients about the VNS program and arrange their initial care transition visit following discharge.
    • Provide in-home visits post-discharge to enhance health literacy and ensure access to necessary care to prevent re-hospitalization.
    • Assist patients in scheduling follow-up telehealth appointments with their primary care providers.
  • Deliver support as part of the care plan, particularly during urgent situations or in conjunction with telehealth services provided by the patient's primary care provider.
    • Stabilize patients at home and coordinate with their primary care provider for further evaluation.
    • Perform patient assessments, gather vital signs, and relay essential information to the primary care provider.
    • Support virtual evaluations during telehealth appointments.
Qualifications:
  • EMT-B Certification and CPR Certification are required.
  • A valid driver's license is necessary.
  • Strong understanding of anatomy and physiology related to patient assessment and care.
  • Excellent written and verbal communication skills for effective documentation and interaction with healthcare professionals.
  • Ability to manage time and patient schedules independently with minimal supervision.
Preferred Qualifications:
  • AEMT certification is preferred.
  • Two or more years of experience in an ambulance setting (active or volunteer) is advantageous.
Physical Requirements:
  • Must be capable of driving, standing, maintaining a stationary position, bending, pulling, pushing, carrying, and lifting up to 50 pounds regularly.
Work Environment:
  • Involves both onsite work in hospital settings and offsite visits to patients' homes.
  • Daily travel between the hospital and patients' residences is a requirement.

Cayuga Health System is committed to providing equitable treatment to all patients, staff, and volunteers, ensuring a safe and respectful environment. We are an Equal Employment Opportunity employer, dedicated to fostering a diverse and inclusive workplace. We do not discriminate based on any protected characteristics.

If you require accommodations during the application process, please reach out to our Talent Acquisition team.



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