Patient Transition Coordinator
1 day ago
We are looking for a skilled and compassionate Patient Transition Coordinator to perform care management duties, assessing, planning, and coordinating medical and supporting services across the continuum of care for post-discharge members. As a key member of our team, you will promote quality and cost-effective care by working closely with healthcare professionals, specialists, and interdisciplinary teams.
Key Responsibilities
- Evaluate member needs through post-discharge assessments for transitions from healthcare facilities
- Assess medication and reconcile between pre-admission and post-discharge medications
- Develop care/service plans in collaboration with discharge planners, providers, specialists, and interdisciplinary teams to support member transition and discharge needs
- Facilitate the transition into active care management based on member needs
- Provide or facilitate education and resource materials to members, authorized caregivers, and providers to promote wellness activities and improve overall quality of care
- Facilitate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical resources as necessary to meet medical and socio-economic needs of members
- May perform telephonic, digital, home, and/or other site outreach to assess member needs and collaborate with resources
Requirements
- Requires a Master's degree in Behavioral Health or Social Work or a Degree from an Accredited School of Nursing and 2-4 years of related experience
- LISW, LCSW, LMSW, LMFT, LMHC, LPC, or RN required
Benefits
- Competitive pay, health insurance, 401K, stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field, or office work schedules.
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