Transitional Care Professional

About the role

We are seeking a Transitional Care Professional to facilitate a smooth transition for patients from hospitals, rehabilitation centers, and skilled nursing facilities to their homes. The role plays a crucial part in enhancing the patient experience and reducing hospital readmissions.

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.
• Schedule essential visits 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.
• Maintain flexibility to work during normal work hours (unless previously approved by direct supervisor).
• Participate in coaching calls.
• Perform other duties as requested or required, in the sole discretion of the Company.

Requirements

• A 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.
• 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.
• 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 a licensed driver with an automobile that is insured in accordance with state and/or organizational requirements and is in good working order.