Patient Transition Coordinator
About The Position
The Patient Transition Coordinator role is responsible for initiating contact with patients for Home Health, Hospice, or Palliative care services. This involves preparing patients for care by gathering essential information such as demographic details, medical history including diagnosis, and primary care physician information. The coordinator also introduces Home Health services, explains benefits, and coordinates clinical information to initiate physician-ordered care. Additionally, they support the Sales team with referral coordination, including obtaining physician signatures, extracting information from EMRs, requesting details from facilities, and conducting bedside meetings with discharging patients. The role also involves providing feedback to referral sources on admissions and non-admit decisions, collaborating with rehabilitation facilities on patient care needs and discharge service potential, and assisting with systems integration and process improvements to enhance patient outcomes and transitions of care.
Requirements
- Demonstrated knowledge of referral source types and community resources
- Excellent organizational skills and ability to complete competing priorities
- High energy level and passionate about care delivery
- Displays a high level of professionalism by exercising appropriate communication, patience, flexibility and a cooperative attitude
- Ability to listen attentively and offer care options based on individual patient health needs
- Proficient computer skills – ability to navigate Microsoft email, word, excel, and agency software
- Must have and maintain a valid Pennsylvania Driver's License
- Must maintain automobile insurance coverage
- Must have access to a reliable automobile
Nice To Haves
- Minimum of two years of experience in a home health setting and/or discharge planning preferred
- Sales experience preferred
Responsibilities
- Initiates contact for Home Health, Hospice, or Palliative care services to assist in preparation for patient care.
- Gathers complete and accurate demographic information, medical history including diagnosis for care, and primary care physician information.
- Introduces Home Health services, explains benefits, and coordinates clinical information to start care for physician-ordered services.
- Assists the Sales team with referral coordination, including obtaining physician signatures, pulling information from EMRs, contacting facilities for more details, and completing bedside meetings with discharging patients.
- Provides follow-up feedback to referral sources regarding admissions and any non-admit decisions.
- Collaborates with rehabilitation facilities regarding patient care needs and discusses potential needs of services at discharge.
- Assists in systems integration and process improvements that result in improved patient outcomes and transitions of care.
- Performs other duties as assigned by supervisor.
Benefits
- Drug screen prior to employment is part of the background process, which includes medical and recreational marijuana.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
