Transitional Care Coordinator

Doctor's Choice Home Care & Hospice Texas • Houston, TX

1d

About The Position

Committed to Caring, the Transitional Care Coordinator (TCC) is a clinical team member of the sales team and is responsible for facilitating a seamless transition for patients discharging from a facility setting to one that facilitates post-acute needs, by communicating and collaborating with both internal and external teams to a support patient-centric care. The TCC will assess patients to determine their level of health literacy, assess for patient and caregiver needs, coordinate between the referral sources and discharge provider to assure needed documentation is obtained, and ensure patients and families are included in care planning. Once the transition is accomplished, the TCC will work and coordinate with the Agency to ensure that there are patient centric plans in place to ensure optimal patient outcomes. The TCC must possess the ability to communicate and collaborate with other individuals in many different settings, utilizing their clinical, sales, marketing, negotiation, problem solving, and analytical skills that lead to company market development initiatives and growth while focusing on serving more patients with excellent outcomes.

Requirements

• A minimum of one (1) year experience in a health care organization, home care and/or hospice preferred.
• LVN, RN, PT, PTA, COTA required.
• CPR certified with American Heart Association or American Red Cross if a clinical.
• Possess excellent written, verbal and listening communication skills
• Ability to manage conflict, stress and multiple simultaneous work demands in an effective, professional manner.
• Ability to work independently, while collaborating with other team members, build relationships and be results driven.
• Strong understanding of customer and market dynamics, as well as transitional care best practices
• Possess sound organizational skills to include time management and problem solving
• Experience with State, CMS and/or accreditation survey process
• Must demonstrate good customer relations skills and a commitment to providing quality service
• Familiarity with healthcare laws, regulations, multiple accreditation standards and elements of performance
• Proficient with a computer and Microsoft Word, Excel and Outlook software.
• Working knowledge of EMR database.
• Ability to work with culturally diverse clients and address low literacy issue in care provision
• Acceptance and ability to demonstrate and support the core values and goals of Agency
• Valid driver’s license, automobile liability insurance and reliable transportation required
• Travel between facilities, hospitals and home care agency is required. Approximately 75%-100% travel.

Nice To Haves

• Associate’s or bachelor’s degree in nursing or allied health preferred.

Responsibilities

• Facilitating a seamless transition for patients discharging from a facility setting to one that facilitates post-acute needs
• Communicating and collaborating with both internal and external teams to a support patient-centric care
• Assessing patients to determine their level of health literacy
• Assessing for patient and caregiver needs
• Coordinating between the referral sources and discharge provider to assure needed documentation is obtained
• Ensuring patients and families are included in care planning
• Working and coordinating with the Agency to ensure that there are patient centric plans in place to ensure optimal patient outcomes

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED