Transitional Care Coordinator

company

Since 2012, this client has been a trusted partner for the nation’s top health plans, health systems, post-acute care providers, and at-risk physician groups navigating the shift from volume to value. Their high-touch, proven care model fully supports patients from pre-acute through to the home. This client's patients can enjoy more days at home, and healthcare providers and health plans can significantly reduce costs specific to unnecessary care and readmissions.

overview

Are you a registered nurse with transitional care experience and excellent communication skills who thrives when making a positive impact on your patients’ lives? Are you dedicated to building strong relationships with others? If so, becoming a Transitional Care Coordinator could be your next career step! In this position you’ll be serving as the communication link between patients and healthcare professionals. You’ll identify the appropriate care setting to make sure that the patient receives the best healthcare services and ensuring a smooth and efficient delivery of care. You’ll also be working with the patient’s family to offer support and information throughout the process. In this position you’ll be part of team that is passionate about patient care while supporting a healthy work/life balance for their employees. If you’re looking forward to making a difference in the lives of others, take the next step by applying below. Duties and Responsibilities: • Collaborates effectively with the patient’s interdisciplinary health care team to coordinate the best transition plan to the most appropriate post-acute care setting • Provides support via phone to patients in order to help them meet their short- and long-term health goals • Communicates with case managers and physicians regarding patients who do not meet criteria and assists with developing a discharge plan • Helps connect patients to community resources and additional services • Utilizes knowledge of behavioral change science and principles to guide patient/caregiver interventions. • Helps address end-of-life issues, including hospice and palliative care options • Demonstrates cultural sensitivity and takes these issues into account when developing care plans • Monitors and evaluates the effectiveness of plans and makes recommendations for changes in the transitional care plan that incorporates transitional needs, as indicated. • Other responsibilities as assigned Requirements: • Registered Nurse with current, active unrestricted licensure in CA required • 5 years of clinical experience • Experience transitioning/discharging patients from acute (required) to Skilled Nursing Facility (strongly preferred) • Case Management experience with CCM preferred • Experience working with geriatric population preferred • CMS and managed care knowledge preferred

benefits