Transitions Coordinator

Hospice of Redmond•Redmond, OR

3d•Onsite

About The Position

Implement and build community awareness of the Transitions Program for the ClearPath Healthcare service area. Coordinate / case-manage client needs and volunteer services. Make referrals to appropriate community services as needed by the client/ family in a timely manner. Interact with Transitions clients and families, Executive Director, Marketing Coordinator, Volunteer Coordinator, volunteers, physicians’ staff, community agencies/ services, and the general public.

Requirements

Self-directed with strong time management skills and the ability to work independently with minimal supervision.
Excel in written and oral communications, including letter correspondence, ad creation, social media communications, and public speaking.
Demonstrate strong interpersonal and communication skills, maintaining effective communication with clients, families, and community partners.
Ability to work in multiple disciplines and with various individuals.
Ability to successfully use a variety of computer applications.
Familiarity with Central Oregon resources related to client advocacy.
Valid Oregon driver’s license and access to adequate transportation to carry out functions

Responsibilities

Provide one-on-one non-medical and case management support to individuals through the mental, physical, and emotional changes that may accompany life-limiting illness.
Process and perform client intakes / admissions as required.
Gather information pertinent to client health care and provide family information regarding community resources.
Work closely with clients in developing and achieving their personal health goals to enhance quality of life.
Assist clients in navigating the healthcare systems, including scheduling appointments and accessing community services and resources.
Advocate for clients' needs and ensure equitable access to healthcare services, community resources, and support programs.
Conduct and document a minimum of one face-to-face visit per month with each assigned client to assess needs, monitor progress toward goals, provide ongoing support, and identify changes requiring intervention or care plan updates.
Communicate with primary care and specialty providers regularly, keeping them informed of client health changes and concerns, as well as services provided, obtaining their approval when appropriate.
Educate and provide information on health topics such as nutrition, physical activity, disease prevention, chronic disease management, and end of life care.
Organize and facilitate workshops, health fairs, and informational sessions to enhance community awareness supporting and working alongside our Community Engagement Manager.
Maintain accurate, timely, and complete chart documentation, ensuring all client visits, communications, care coordination activities, and services are charted daily in accordance with organizational requirements.
Maintain monthly statistical reports, tracking referrals.
Maintain regular and professional communication with supervisors and team members to support coordination of services, continuity of care, and organizational goals.
Maintain confidentiality of client information, adhering to HIPAA policy.
Basic ability to work with ill & dying clients with respect to their individuality, values and lifestyle.
Speaking with clients and providing education on end-of-life care and supporting their goals.
Demonstrates ability to prioritize under pressure.
Other duties as required