Acute Care Transitions Engagement Specialist

DIRECTION HOME AKRON CANTON AREA AG•Green, OH

1d•$46,000 - $55,500

About The Position

The Acute Care Transitions Engagement Specialist supports the Program by engaging members after discharge from acute care, post-acute facilities, or emergency department encounters. The role conducts timely outreach, explains program services, encourages participation, and schedules home or telehealth visits during facility stays and after discharge. The Specialist manages daily census reviews, documentation, member logs, geographic zoning, scheduling workflows, and coordination with Program Coaches and community partners to support timely transitional care. The work is primarily telephonic and includes research using technological platforms, including the HIE. Outreach volume may reach 50–60 member calls and 60–80 chart reviews or facility outreaches per day. The position is full-time and located in Uniontown, Ohio. The listed salary range is $46,000–$55,500 per year.

Requirements

High school diploma.
At least 1 year of experience in customer service, sales, administrative support, or a related role.
Optimal proficiency with Microsoft Office applications, including Outlook and Excel.
Strong organizational, communication, and multitasking skills.

Nice To Haves

Experience in medical scheduling, care coordination, or clinical support roles.
Background in healthcare, nursing support, or medical office operations.
Familiarity with care management workflows or value-based care programs.
Experience working with multi-provider or multidisciplinary teams.
At least 2 years of college education.

Responsibilities

Organize daily workflows, including incoming censuses, call logs, and zoning assignments for Program Coaches.
Review the daily MMO census and assign members to Coaches according to risk tier, visit type, geography, and productivity targets.
Conduct telephonic member outreach and research through technological platforms, including HIE research.
Update scheduling templates, calendars, and visit assignments across multiple platforms using available resources to determine member demographics.
Zone visits efficiently to minimize travel time and support Program productivity.
Identify and promptly resolve scheduling conflicts and cancellations.
Use Excel to sort, filter, track, and prioritize daily censuses and visit needs.
Enter and update member information and calls accurately and promptly in the documentation platform.
Use the HIE to verify admissions, discharges, transfers, and clinical status changes.
Provide administrative support, including documentation cleanup, call-attempt tracking, and census reconciliation.
Explain Program services clearly and encourage member enrollment, seeking to engage members as early as possible and ideally before discharge.
Document outreach efforts promptly and maintain organized, aligned scheduling records across platforms.
Identify clinical details that affect scheduling decisions and adjust scheduling scripts accordingly.
Communicate relevant clinical information to Nurse Coaches and follow agency protocols when relaying information or preparing Coaches for visits.
Track SNF outreach, follow up on missed outreach, and coordinate rescheduled visits.
Communicate with post-acute staff when appropriate to promote member engagement.
Escalate complex cases to Supervisors for troubleshooting, with the goal of promoting engagement and reducing member abrasion.
Perform other job-related instructions as requested.