Transitional Care Coordinator
The Care Coordinator is responsible for identifying the appropriate Post-Acute Care (PAC)
Evaluating a defined population for transitional needs post-discharge to improve outcomes
Ensure that efficient, smooth, and prompt health care services will be delivered to the patient across the continuum of care, beyond a single episode of care and addresses the ongoing needs of the patient
TCC engages the hospital care team, the physicians, post-acute care providers in the home or home-like setting, the patient and their families/caregivers while providing objective information and support throughout the care continuum focusing on safe transition of care
Registered Nurse with current, active unrestricted licensure required
Current active unrestricted clinical license required
5 years of clinical experience.
Case Management experience with CCM preferred.
Patient education background, rehabilitation, SNF and/or home health nursing experience a plus.
Experience working with geriatric population preferred.
Excellent documentation and technology skills required
Self-starter with the ability to prioritize daily work load.
Strong interpersonal and communication skills (both verbal and written).
CMS and managed care knowledge preferred.