Transition Care Coordinator - Case Management - Full-time Days
At Steward Health Care System, we are committed to improving the health of our communities by delivering exceptional, personalized care with dignity, compassion and respect. Our continued focus on the patient experience informs our caregivers in how to provide care that is respectful of and responsive to individual patient and family preferences, needs and values.
We dedicate ourselves in the communities we serve to delivering affordable health care to all and being responsible partners. No matter what your role, as a member of the Steward family, you are a specialist in the making every patient and family feel right at home, every co-worker a key to our success, and every referring practice, a team of prized colleagues.
In support of this, we commit ourselves to the following values:
If you are seeking a fast-paced, challenging position in an organization committed to achieving and maintaining a standard of excellence in all we do, our organization may be a good fit for you.
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 transition care. Transition Care Coordinator will provide assistance to patients, families, and/or significant others. Facilitates assistance when psychosocial factors impact the recovery process. The Transition 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. Transition 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.
Steward Health Care is an Equal Employment Opportunity (EEO) employer. Steward Health Care does not discriminate on the grounds of race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity and/or expression or any other non-job-related characteristic.
Important COVID message
Please note, our Sharon Regional Medical Center is taking additional, necessary preparations to ensure patients can receive compassionate care in a safe, carefully managed environment - with confidence and without fear. Our Safe and Ready program consists of a rigorous [five-point] standard ensuring patient safety, confidence and convenience: Expanded hours will allow previously canceled procedures to be scheduled as quickly as possible. Any COVID-19 related care takes place in designated areas away from other patients and their families. Emergency Departments are reorganized to be a safe place to treat all emergency patients. A stringent cleaning policy has been implemented throughout the hospital. A strictly controlled visitor and masking policy is required for patient safety. You can rest assured that we have made the necessary preparations to provide care in a safe, controlled and professional way.