Hospital Transition Coordinator - Baltimore (#0058)
Our client, a large healthcare insurance provider in the Mid-Atlantic region, is currently looking for full-time Hospital Transition Coordinators to work in the Baltimore area.
Under the general direction of the Manager and Supervisors of the Care Transition Program, the incumbent’s accountabilities include, but are not limited to, the following:
Rapidly triages members into the appropriate level for the Care Transition program.
? Understands the Care Transitions concept and protocols, can advocate for the member.
? Contemporaneously, identifies members for program participation based on program guidelines, analytics and using clinical judgment.
? Engages members to participate in the Care Transition program and establishes relationship and follow up plan for ongoing care coordination and assessment
? Assures patient understanding of adequate support upon transition and knowledge of who to call if problem arise. Collaborates with facility staff as necessary to close gaps when identified.
Implements an effective Care Transition program for members identified.
? Meets with identified members while hospitalized. Discuss and reviews the discharge plan, address member concerns.
? Actively follows up with identified participants post discharge to verify appropriate transition plan. Using their clinical judgment, the Hospital Transitions Coordinator assesses the discharge plan for outpatient follow-up visit, ordered tests, DME or services, and medication reconciliation.
? Coordinates necessary interventions
? Communicates with the PCMH when members are attributed, to improve the transition from another level of care.
? Primary role as coordinator/facilitator—proactively guiding members to the appropriate programs and resources designated as best, to achieve program goals of reduced readmissions, cost-efficiency and quality outcomes.
? Ensures the transition of care from one setting to another for identified members. Provides member centric interventions such as verifying appointments and coordinating medically necessary home health services.
? Proactively identifies, assesses, and coordinates health care services based on the member’s needs and benefits.
? Coordinates appropriate referrals for Care Management Programs, such as Case Management, Disease Management, Wellness and Medication Reconciliation and communicates with those referral sources to improve transition.
? Offers assistance to members and providers for alternative settings of care.
Communicates and interacts professionally with physicians, members and other providers.
? Builds and maintains a solid professional relationship with all of the targeted facilities and is proficient and knowledgeable about the Care Transition model. Communicates regularly with the Plan on the operational issues/concerns and barriers.
? Improves communication during transitions between ,providers, members and caregivers to assure smooth transitions
? Provide timely and accurate communication of information as members transfer from one level of care to another.
* Onsite hospital assignments subject to change based on evolving business need. *
Requires a bachelor’s degree in Nursing or equivalent experience and must have 7-10 years of increasingly responsible hospital related experience working in Care Management, Discharge Coordination, Home Health, or Disease Management. Must possess extensive knowledge of how to manage care delivery guidelines and systems. Proven care management experience is critical.
The incumbent must have excellent analytical and problem solving skills, excellent organizational, communication and coordination skills. The incumbent must have effective presentation, negotiation and influencing skills to interface with all levels of management and physician practices. The incumbent must be able to apply complex problem solving abilities to achieve problem and process solutions.
The incumbent is required to have had the vaccinations listed below and been appropriately screened (and cleared) for the items listed below. If the incumbent has not had them or been screened and cleared, they must do so upon acceptance of offer:
? TB screening (and repeat annually)
? MMR-V Immunity
? Influenza Vaccine (Seasonal)
The incumbent is required to complete the following training as assigned by Management, including, but not limited to:
? Infection control basics
? TB Awareness
? Bloodborne Pathogens
A current DC, MD, or VA Registered Nurse License is required.
MSN or CCM, and familiarity with web based software application environment
Potential Job Hazards:
The position is located within an inpatient hospital facility.
? Incumbents are required to state their purpose upon arrival to the member’s room so there is no confusion as to their role vs. the role of the direct care hospital staff.
? Incumbents do not provide any form of direct patient care.
? There is the potential for exposure to airborne illnesses, such as, but not limited to, tuberculosis, measles, mumps, rubella, varicella and influenza. The following administrative controls are in place to limit or minimize exposure potential:
? Incumbents do not enter any inpatient rooms, or hospital rooms designated with Respiratory precautions, or where any procedures are being done that produce respiratory droplets.
? Incumbents are required to remain at least 3 feet away from the inpatient member at all times.
? There is the potential for exposure to Bloodborne Pathogens if not aware of surroundings at all times. The following administrative controls are in place to limit or minimize exposure potential:
? Incumbents do not touch patients;
? Incumbents must practice Universal Precautions at all times.
Prior to being submitted for consideration, all candidates must take (and pass) an online assessment test which will gauge aptitude on skills such as basic computer literacy, patient focus and management, verbal ability, and work focus.
Interested and qualified candidates should apply immediately!!