Transitional Care Coordinator

3 weeks ago

Braselton, Georgia, United States Northeast Georgia Health System, Inc Full time
About the Role

We are seeking a highly skilled Transitional Care Coordinator to join our team at Northeast Georgia Health System, Inc. As a key member of our healthcare team, you will play a vital role in ensuring seamless transitions for our patients from hospital to home or other care settings.

Job Summary

The Transitional Care Coordinator will provide comprehensive support to our Case Management team, assisting with discharge planning, continuum placement, and communication with insurance companies. This role requires excellent communication skills, judgment, and maturity, with the ability to interact with patients, staff, and personnel across various age groups.

Key Responsibilities
  • Supports a collaborative practice environment, utilizing a team approach to ensure coordination of services and enhance continuity of patient care.
  • Documents activities in patient records in a consistent and timely manner, including progress toward goals, discharge planning, and continuum placement.
  • Responds to all referrals on the same day received, as evidenced by documentation in the medical record.
  • Performs all tasks in a timely manner and assists in monitoring length of stay.
  • Reviews patient medical records for appropriate documentation as requested.
  • Assertively seeks nursing home placement once the need is identified, through timely form completion, faxing, and expedient communication with all parties involved.
  • Obtains post-acute authorizations as required.
  • Arranges appropriate discharge services for patients per physician orders, including but not limited to: Hospice, DME, Home Health Services, indigent medications from the pharmacy, transportation home, follow-up appointments, etc.
  • Completes transfer forms for patients moving within and outside the continuum of care.
  • Prepares DMA-6 from the medical record for patients going to SNF.
  • Provides the requested information to nursing homes and third-party review agencies and provides follow-up for successful patient placement.
  • Arranges DME and/or home health services for patients per physician orders.
  • Arranges post-acute transportation in accordance with medical necessity, payor benefits, indigent process (ex. Taxi, Lyft).
  • Provides the requested information to assisted living facilities and personal care homes and provides follow-up for successful patient placement.
  • Serves as an advocate for the patient while assisting the patient in navigating the healthcare delivery system.
  • May require face-to-face interaction at all campuses or patient location.
  • Facilitates communication among the patient, their families/caregivers, healthcare providers, post-acute providers to enhance cooperation while planning for and meeting the healthcare needs of the patient.
  • Facilitates post-discharge follow-up by scheduling appointments, transport, and referrals to post-acute providers.
Requirements
  • High School Diploma or GED.
  • Two (2) years of healthcare experience.
  • Current Georgia LPN license preferred or Associates Degree in the Health or Human Services.
Preferred Qualifications
  • Current Georgia LPN license.
  • Licensed Practical Nurse with an active Georgia license preferred or Associates Degree in the Health or Human Services.
Physical Demands
  • Weight Lifted: Up to 20 lbs, Frequently 31-65% of time.
  • Weight Carried: Up to 20 lbs, Frequently 31-65% of time.
  • Vision: Moderate, % of time.
  • Kneeling/Stooping/Bending: Frequently 31-65%.
  • Standing/Walking: Frequently 31-65%.
  • Pushing/Pulling: Frequently 31-65%.
  • Intensity of Work: Frequently 31-65%.
  • Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding, Driving.

We offer a competitive salary and benefits package, as well as opportunities for growth and professional development. If you are a motivated and compassionate individual who is passionate about delivering exceptional patient care, we encourage you to apply for this exciting opportunity.

Northeast Georgia Health System, Inc. is an Equal Opportunity Employer and welcomes applications from diverse candidates.

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