Transitional Care Professional

Your Health Organization•Aiken, SC

1d•Hybrid

About The Position

We are seeking a qualified candidate to act as the clinical liaison for our patients throughout the Aiken / Augusta areas. The Transitional Care Professional position plays a crucial role in facilitating a smooth transition for patients from hospitals, rehabilitation centers and skilled nursing facilities to their homes by providing comprehensive care coordination and support. The Transitional Care Professional plays a vital role in enhancing the patient experience and reducing hospital readmissions. Transitional Care Professional perform visits in homes and facilities (ALF and ILF's) in their designated service area. You must have reliable transportation as travel is required daily. This is a full time, salary-based working 8-hr shifts Monday-Friday (8am-5pm). The following service area(s) are currently available: Aiken area.

Requirements

Certified Medical Assistant, Paramedic, or Licensed Nurse preferred.
Certifications or licenses must be in good standing.
Previous experience in public health or home health preferred.
A minimum of three (3) years clinical experience preferred.
Demonstrated ability to supervise and direct professional and administrative personnel.
Ability to read and communicate effectively.
Strong written and verbal skills.
Strong organizational and time management skills, with the ability to multitask and prioritize responsibilities effectively.
Basic computer knowledge.
Ability to manage and demonstrate effective leadership skills.
Should demonstrate good interpersonal and communication skills under all conditions and circumstances.
Ability to foster a cooperative work environment.
Team player with ability to manage multiple responsibilities and demonstrate sound judgment.
Must be able to work flexible hours and travel between offices, facilities, etc.
Must be a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order.

Responsibilities

Visit the Company’s referrals and established patients within assigned facilities.
Establish trust and rapport with patients to assist them in making informed decisions regarding their health during their stay in the facility.
Provide guidance and feedback to patients based on recommendations from the care team regarding their care.
Ensure a seamless transition for patients returning home by arranging the necessary services, such as home health, outpatient rehab, and follow-up care with the Company’s providers and support staff.
Ensure all essential visits are scheduled including those with the Company’s primary care provider, virtual provider, specialists, pharmacists, social workers, etc.
Facilitate effective communication between healthcare professionals involved in the patient’s care.
Ensure patient and family adherence to the plan of care.
Interact with patients via phone, email, patient portal, telephone, AthenaText, in person, etc. to gather necessary information.
Provide exceptional customer service to patients, exhibiting a compassionate and empathetic attitude and a patient-centered approach to care.
Address patient concerns, inquires, and complaints professionally and promptly, striving to meet patient needs and ensure their satisfaction.
Perform general administrative tasks and support other staff as needed.
Utilize the company’s software systems to enhance patient care and staff efficiency.
Must be available during normal work hours (unless previously approved by direct supervisor).
Utilize the company’s software systems and update information as required.
Participate in coaching calls.
Perform other duties as requested or required, in the sole discretion of the Company.