Transitional Care Coordinator
About The Position
The Transitional Care Coordinator plays a key role within the Quality team, contributing to improving care coordination and ensuring timely follow-up after hospital discharge. This position is responsible for coordinating post-discharge appointments, retrieving hospital records, and supporting transition of care processes that impact quality outcomes. The role also supports quality initiatives through basic data collection, tracking, and reporting related to care coordination and follow-up activities. The role ensures patients are scheduled appropriately and necessary information is available for follow-up care. The role collaborates closely with the Quality Manager, Chief Compliance Officer, and other internal stakeholders to support quality initiatives by ensuring effective transitions of care, reducing gaps in follow-up services, and contributing to performance improvement efforts.
Requirements
- Minimum of 2 years in healthcare, practice management, or a related field.
- Demonstrated oral and written communication skills.
- Strong knowledge of healthcare, clinical fundamentals and preventive healthcare standards
- Computer skills and knowledge of applicable software programs including Excel, Word, and PowerPoint.
- Ability to work with diverse populations.
Nice To Haves
- Bi-lingual preferred but not required
Responsibilities
- Supports care coordination and transition of care workflows, including post-discharge follow-up and appointment scheduling, as assigned.
- Assist in the collection, organization, and basic analysis of patient care data related to clinical quality metrics, including UDS, HEDIS, and internal performance indicators.
- Monitor and help close preventive care gaps by identifying needed services and communicating this information to care team members.
- Conduct patient outreach, discussing preventive screenings, and documenting patient interactions in the electronic health record (EHR).
- Support quality improvement activities by participating in team meetings and improvement cycles (e.g., Plan-Do-Study-Act).
- Upload documents and maintain accurate records in the EHR to ensure data integrity and proper tracking of quality measures.
- Collaborate with clinical staff to provide reminders about care gaps and assist with patient follow-up efforts.
- Utilize data tools such as registries and reports to help identify trends, patient needs, or areas for improvement.
- Communicate effectively with team members and departments regarding quality-related information, initiatives, and processes.
- Assist with preparation of quality reports and presentations for internal stakeholders.
- Support internal audits and assist during regulatory or compliance reviews as needed.
- Identify patients with Limited English Proficiency (LEP) or other communication needs and coordinate appropriate interpretation services.
- Perform other related duties as assigned, supporting the organization’s commitment to improving patient outcomes and quality of care.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
Number of Employees
1-10 employees
