Care Transitions Coordinator

4 weeks ago


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

Eliot's Behavioral Health Division is seeking a highly motivated and experienced 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 among individuals with psychiatric disabilities.

Key Responsibilities
  • Collaborate with Nurse Care Managers to triage hospital admissions data and develop assertive follow-up strategies to engage with hospital treatment teams and enrollees during inpatient admissions.
  • Facilitate collaborative discharge planning processes for hospitalized enrollees, ensuring 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, as dictated by MassHealth contract.
  • Communicate discharge disposition updates to assigned Care Managers throughout enrollee inpatient admissions and consult with and/or directly involve assigned Care Managers 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 the 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 Certified Recovery Coach.
  • Strong commitment to mental health recovery, substance abuse disorders, care coordination, and wellness.
What We Offer

Eliot offers a competitive salary of $50,000 annually, with a 6% bilingual differential (Spanish). We are committed to creating an inclusive and equitable work environment that values diversity and promotes professional growth.



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