Care Transition Specialist
3 weeks ago
Molina Healthcare Services is seeking a skilled Care Transition Specialist to join our team. As a key member of our multidisciplinary team, you will work closely with members, providers, and other stakeholders to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum.
Key Responsibilities:
- Collaborate with hospital discharge planners, hospitalists, outpatient providers, facility staff, and family/support network to ensure safe and appropriate transitions.
- Conduct face-to-face visits of all members while in the hospital and home visits of high-risk members post-discharge.
- Coordinate care and reassess member's needs using the Coleman Care Transitions Model recommended post-discharge timeline.
- Educate and support members focusing on seven primary areas: medication management, use of personal health record, follow-up care, signs and symptoms of worsening condition, nutrition, functional needs, and Home and Community-based Services.
- Assess for barriers to care, provide care coordination and assistance to members to address concerns.
Requirements:
- Graduate from an Accredited School of Nursing.
- Active, unrestricted State Registered Nursing (RN) license in good standing.
- 1-3 years hospital discharge planning or home health experience.
We Offer:
- A competitive benefits and compensation package.
- A dynamic and supportive work environment.
Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V.
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