Onsite Transition Care Coordinator

Sentara Hospitals•Harrisonburg, VA

3d•Onsite

About The Position

The Regional Transition Care Coordinator (TCC) is responsible for managing and supporting all transitional care and post-acute services to members in a geographical region. Care transitions include transitioning individuals from Nursing Facilities, hospitals, inpatient rehabilitation, or other institutional settings into the community, and assisting individuals who desire to remain in their community setting. The TCC will work in collaboration with the Care Coordinator, Interdisciplinary Care Team Meetings, and facilities to facilitate a safe and effective transition. The TCC will plan, coordinate, monitor, and evaluate options to meet the individual's needs prior to transition back out into the community-based setting. The TCC will ensure a smooth hand off is given to the receiving Care Coordinator assigned to the individual.

Requirements

ALD - Associate's Level Degree, MLD - Master's Level Degree, BLD - Bachelor's Level Degree, N-3YR - RN-Diploma (Non-degree) REQUIRED
One of the following licenses or education is required: RN, LPN or Bachelors degree in Health & Human Services. LCSW or LPC licensure also acceptable for certain positions REQUIRED
A minimum of two (2) years of Case Management Experience or Long-Term Care Experience REQUIRED
Job Experience in Nursing, Social Work or Human Service Field REQUIRED
One year working with Medicaid or CCC Plus populations, licensed in the state of VA REQUIRED

Nice To Haves

Health plan (Medicaid and DSNP) and TOC experience preferred

Responsibilities

Managing and supporting all transitional care and post-acute services to members in a geographical region.
Transitioning individuals from Nursing Facilities, hospitals, inpatient rehabilitation, or other institutional settings into the community, and assisting individuals who desire to remain in their community setting.
Work in collaboration with the Care Coordinator, Interdisciplinary Care Team Meetings, and facilities to facilitate a safe and effective transition.
Plan, coordinate, monitor, and evaluate options to meet the individual's needs prior to transition back out into the community-based setting.
Ensure a smooth hand off is given to the receiving Care Coordinator assigned to the individual.

Benefits

Medical, Dental, Vision plans
Adoption, Fertility and Surrogacy Reimbursement up to $10,000
Paid Time Off and Sick Leave
Paid Parental & Family Caregiver Leave
Emergency Backup Care
Long-Term, Short-Term Disability, and Critical Illness plans
Life Insurance
401k/403B with Employer Match
Tuition Assistance – $5,250/year and discounted educational opportunities through Guild Education
Student Debt Pay Down – $10,000
Reimbursement for certifications and free access to complete CEUs and professional development
Pet Insurance
Legal Resources Plan
Colleagues may have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met