Unique Opportunity for a Care Transition Coordinator with a Home Health Leader - Become A Senior Advocate!WILLCARE is a proud member of Almost Family, a leading provider of home health nursing, rehabilitation and personal care services. Our Senior Advocacy Mission raises the bar with programs designed to achieve better outcomes for our patients. For over 30 years, we have developed a culture that fosters innovation, clinical excellence, and integrity.Why consider choosing a career with us? Because we are committed to helping you achieve your goals. As a member of our Senior Advocacy Care Team, we are confident you will achieve more for your career with industry-leading specialty programs that enhance care and promote better outcomes for patients. Receive courses to advance your skills as a geriatric specialist. You will also enjoy the support of a progressive group along with great benefits, competitive pay, and flexible schedule options to fit your lifestyle. If a long tradition of world-class caring is important to you, consider joining our team. You'll feel right at home.
POSITION SUMMARY: The Care Transition Coordinator (CTC) is a clinical liaison position between the agency and local community health care providers to ensure continuity of care for patients transitioning from a facility to home care environment.
Referral coordination for home health services and proactive communication withtransition from the inpatient to the home setting
CTC must be available to accept and/or respond to phone calls from facilities in avery timely manner.
Primarily conducts pre-discharge hospital visits at the physicians' request todetermine the eligibility for home health services.
Ensures effective communication and collaboration with Central Intake viadaily or weekly meetings.
Actively participates in marketing presentations and meetings with Case Managers, bringing relative data and reports to the meeting for review as well as information regarding changes.
Responsible for establishing, growing and maintaining relationships with facility-based referral sources by both communicating with existing referral sources and identifying new opportunities.
Assists in developing the business and referral relationships of the agency within thecommunity. Maintains positive relationships with referral sources and communityorganizations, facilitates communication between referral sources, client and familypopulations, and attends professional organization meetings.
Once the physician refers and patient has chosen Almost Family, CTC provides thereferral information to Central Intake for the patient to be assessed at home by a nurse who reviews the physician order, assess the patient's clinical needs, and reviews clinical information from the hospital.
Communicates to patient so that there is a clear understanding of Home Care andsetting appropriate expectations with them including when they should be expecting aphone call for scheduling. Ensures that the patient has appropriate collateralthat will help them to identify who their Home Care Company is as well as generaleducational material so they can be familiar with Almost Family before receiving a visit in their home.
Talks with patients (when possible/permitted by Hospital) insuring that all patientdemographic info is correct (address/phone number/immediate destination upon discharge).Determines patient's aftercare upon release from the hospital to determine if patientwill return to his/her residence or that of a family member.
Defines who the patient's community PCP is or who they will be following up withupon discharge from the hospital. Information must be included on the referralsheet or communicated to Central intake.
Promotes exemplary customer service to physicians, facility personnel, client andclient family at all times.
Provides input to care plan development and informs the location (Central Intake) of patient's acceptance and ensures that the patient's needs are appropriately matched.
Compliant with all processes and expectations as well as compliant with applicablelaws, regulations and Almost Family's compliance plan.
Copies all medical records pertinent to Home Health care and arrange neededequipment only if the Case Manager requests our assistance to do so.
Must be a licensed Registered Nurse (RN) or Licensed Practical Nurse (LPN) in the state of practice.
Minimum of two years of experience in home care required.
Excellent interpersonal skills.
Strong communication skills.
Ability to handle multiple deadlines and a fast-paced environment.
Must demonstrate the ability to communicate effectively with all members of the health care team. BENEFITS OVERVIEW:
Almost Family offers a competitive salary and benefits package that helps safe guard your health and well- being, and provides savings options for you and your family.We offer the following benefits to full time employees: