Transitional Care Manager
About The Position
The Transitional Care Manager coordinates discharge services with agency and hospital staff to support smooth transitions to appropriate care, community reintegration, and reduced avoidable emergency room visits and hospital readmissions. The role conducts screenings and brief assessments, uses existing assessment information to support discharge planning, and coordinates services and supports with families and treatment teams. It also provides education and face-to-face contact, supports referrals and transportation, and maintains required documentation. Work is performed independently in the field, primarily in hospital settings, with variable hours.
Requirements
- Equivalent formal training in behavioral health, usually through a major in Psychology, Social Work, Counseling, or Criminal Justice as part of a bachelor’s degree program.
- Maintain current knowledge of standards of care and practices, typically acquired through continuing education.
- Valid state-issued driver’s license.
- Prepare basic correspondence and simple reports using Microsoft Word.
- Use Microsoft Excel to create tables and simple displays of information.
- Create basic presentations using Microsoft PowerPoint.
- Demonstrate necessary proficiency with the company’s electronic clinical systems, including EHR and scheduling systems.
- Display basic organizational skills to prioritize and organize one’s own work.
- Determine effective responses to situations within established precedent.
- Communicate opinions drawn from conclusions using inference and logic.
- Exercise tact and diplomacy when resolving mild conflicts or disagreements.
Responsibilities
- Conduct screenings and brief assessments to identify individuals’ needs and goals upon discharge.
- Use WVHIN to review existing assessment information and assist with discharge planning and transition.
- Collaborate with families and treatment teams to confirm services and supports are in place for successful transitions.
- Participate in all treatment plan meetings for assigned individuals.
- Arrange and/or provide transportation for individuals served.
- Facilitate referrals to agency programs.
- Prepare and maintain documentation within program guidelines.
- Provide face-to-face contact within program guidelines.
- Educate individuals, families, and hospital staff as needed about individuals’ needs, rights, and community resources.
- Encourage individuals to remain in a continuum of care to support successful outcomes.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
