Care Transition Associate

Care Transition Associate

The Care Transition Associate performs a variety of patient-centered administrative tasks to support care coordination within acute care hospital hubs. This care transition work is focused on post-acute care needs for patients requiring home health and hospice. Support patients and families with their specific discharge plan and plan of care for home health and hospice referrals. The Care Transition Associate ensures a high level of customer service and connection between the hospital's patients and post-acute service providers by assisting patients and the clinicians who provide care to access appropriate post-acute care and effectuate a timely start of care. This role will support care coordination activities furnished within the Providence hospital and develop opportunities for educational outreach that will enhance service awareness and access. Additional duties assigned may include collaboration with local Service Line leadership in essential meetings, reporting on tactical plans, and training/orientation.

Major challenges include demonstrating the ability to cope with an ambiguous and changing environment, remaining calm under pressure, establishing and maintaining positive working relationships with facility customers and JV hospice and home health agency staff, prioritizing multiple tasks and working in a demanding, active setting, and understanding the purpose and function of the Value-Based Enterprise agreement between Providence and JV for home health and hospice care coordination.

Position specific responsibilities include acting as a non-clinical liaison between inpatient and outpatient settings supporting post-acute service arrangements and coordination of care for patient discharge, assisting the Clinical Liaisons and the inpatient acute care teams in arranging care for patients discharging with Home Health and Hospice care needs, obtaining information to help Clinical Liaisons assess patient appropriateness for hospice and home health services, providing in-person education materials and consultation to patients and families regarding Home Health and Hospice, communicating clearly to physician and provider offices verifying orders, providing administrative support for Clinical Liaison team, efficiently navigating EMR; entering patient data and appropriate documentation ensuring a high level of accuracy, supporting coordination of referral and reimbursement, demonstrating and maintaining up to date knowledge and understanding of community resources and payer source criteria for Home Health and Hospice services, effectively managing customer resolution issues independently and seeking management/leadership involvement if necessary, ensuring proper handling and disposal of confidential information and adhering to all HIPAA rules and regulations, maintaining confidentiality of all patient demographics, medical and financial information at all times, attending scheduled meetings and engaging in communications with Clinical Excellence Team, acquiring current knowledge of multiple managed care contracts and network provider subcontracts, working cooperatively with Hospital discharge planning team to identify patients who would benefit from home-based care and to effectuate efficient and effective discharges in cooperation with patient's physician/mid-level provider, and performing other duties as assigned.

Education and/or experience required includes an Associate's Degree or equivalent education/experience, demonstrated work experience with patients and families, work experience, preferably in health care setting, providing customer service and administrative support to professionals, and no requirement for certifications, licenses, and registrations.

Skills include mathematical skills, language skills, and other skills and abilities such as developing strong, collaborative working relationships, managing multiple competing priorities, adapting to an ambiguous and changing environment, working under stress with multiple demands by others, and getting along well with others.

Physical demands and work environment include regular standing, walking, and manual dexterity, the ability to lift and move objects up to 25 pounds, and visual acuity requirements.

This is a full time, in-person position supporting our Home Health team out of Providence St. Jude's Medical Center in Fullerton, CA. Compensation range is $24.00 - $35.77 hourly.