Transitional Care Coordinator

Location: Sharon Regional Medical Center

Posted Date: 3/11/2021

Under the direction of the Director/Care Management, coordinates and implements the function of transition planning for inpatient and outpatient services. Identifies and anticipates transitional care planning needs for each identified patient. Communicates and collaborates with the patient and post-acute primary providers through verbal and written communication. Responsible for the integration of the patient into the care of post-acute primary care using standards of transitional planning in accordance with existing federal, state, and local standards. Adheres to confidentiality policies specific to communication, record keeping, and coordinator of services. Responsible for documentation in all areas of transitional care. Transitional Care Coordinator will provide assistance to patients, families, and/or significant others. Facilitates assistance when psychosocial factors impact the recovery process. The Transitional Care Coordinator is responsible for applying medical necessity criteria to patients entering the hospital. Education is provided to physicians and other members of the team on the issues related to utilization review including inappropriate admissions and placements. Acts as patient advocate by negotiating for, and coordinating resources with payers, agencies and vendors for treat and release patients as appropriate. This position is responsible for implementing specific readmission prevention activities in collaboration with the physician and hospital staff, such as collection patient clinical and demographic data, educating the patient and family on disease management strategies, arranging for post-discharge support services. Transitional Care Coordinator seeks guidance from Director of Care Management as needed.

Requirements: Associate RN degree. 2-4 years experience in healthcare preferred. Ability to read and communicate effectively in English required. Ability to communicate in additional languages preferred. Two years experience as a Care Manager preferred. Experience in status management and transitional care preferred. Case Management Certification preferred. Must have working knowledge of MS office to include Word, Excel, Power Point. Working knowledge of medical terminology required. BLS required. Clearances as required by state and federal guidelines.