Transitional Care Coordinator - Home Health
HRS is now part of the AccentCare family, an ever-growing organization that is committed to quality care in our communities.
AccentCare is looking for passionate clinicians committed to delivering exceptional care in the home.
We are committed to quality patient outcomes—delivering evidence-based care in the home—and providing comprehensive training to further develop our staff along with continuing education and promotional opportunities.
Come join the AccentCare team and Make A Difference every day.
As a Care Transition Staff you will:
- Manage the communication channels between physicians, social workers, discharge planners, Hospital case managers, Home Care Navigators, and agency staff by ensuring that all are aware of referral source requests and concerns; communicating information, questions, and status reports from the patient care staff to the referral source; establishing a system for handling non-admits and communicating this information to the referral source.
- Coordinate and communicate care needed and relays concerns of physician and staff prior to admission or resumption of care for a patient to the agency staff and during course of treatment.
- Take orders from the physician regarding patient care and communicates it to agency staff and maintains a current referral base of all referral sources within the service area.
- Facilitate patient referral for admission if requested prior to the patient’s discharge from the hospital.
- Primarily conduct pre-discharge facility visits at the physicians’ request to determine the need/eligibility for home care.
- Transition patient navigation to Home Care Navigators to establish physician follow up post discharge and ongoing care.
- Manage and grow referral sources by identifying new referral sources and educating them on available services provided by the agency, maintaining current referral source relationships.
- Inform hospital personnel, patient and/or family of case acceptance and documents all demographic, clinical, payer and other information as required on company approved forms to support diagnosis and home healthcare orders.
- Provide input to care plan development. Assist branch in timely processing of physician orders.
- Collaborate with Account Executives in educating the referral sources at large.
- Ensure effective communication and collaboration with branch staff and field sales resources via weekly meetings.
- Actively participate in weekly branch sales/operations meetings, bringing relative data, reports for review as well as information regarding changes within accounts and referral sources.
- Build and maintain patient relationships by keeping up contact with hospitalized agency patients to ensure positive patient experience.
- Comply with applicable legal requirements, standards, policies and procedures including, but not limited to the Compliance Program: Code of Conduct, HIPAA and Documentation Standards.
- Maintain a commitment to the values and mission of Accent Care.
- Perform other related duties as assigned.
Requirements of Qualified Candidates:
- 1 – 3 years of experience in facility relationships and an understanding of facility discharge processes
- Clinical background preferred
- Current driver’s license and liability insurance
- Firm working knowledge of concepts, practices and procedures and ability to use in varied situations
- Able to some advanced skills that allow employee to adapt and meet some complex or non-routine situations
- Strong project/process/time management skills
- Ability to create complex documents, spreadsheet analysis models, and advanced graphics
- Excellent ability to draft, edit, and proofread internal and external correspondence, ensure files are organized, manage electronic schedule as appropriate
- Strong written and verbal communication skills with quick response time
- Ability to work in a fast paced, multi-task environment with competing priorities
- Ability to multi-task and prioritize during high volume, high demand time
- Excellent interpersonal/listening skills
- Proficient in interacting with and creating a collaborative working environment amongst and stakeholders at all levels of the organization
- Possess a responsible, detail-oriented, results-driven work ethic