Care Transitions Specialist

As a Part-Time Care Transitions Health Coach, you will play a pivotal role in improving the health and well-being of residents across our county by helping patients and caregivers successfully navigate one of the most vulnerable moments in healthcare, the transition from hospital to home. In this role, you won’t just provide support; you will empower individuals with the knowledge, confidence, and tools they need to take control of their recovery and maintain their independence. If you are passionate about empowering others, advancing health equity, and creating lasting community impact, this role provides an opportunity to turn that passion into measurable change. About This Role: The Part-time Care Transitions Health Coach works directly with patients through telephonic hospital outreach, post-discharge home visits, and follow-up phone calls. Through education and personalized support, the coach helps patients understand their medications, navigate follow-up care appointments, recognize warning signs or symptoms, and develop self-management strategies that promote long-term wellness and independence. This role emphasizes patient-centered care, collaboration with healthcare providers, and fostering self-advocacy to ensure successful recovery outcomes and improved quality of life. Minimum Requirements: High school diploma or G.E.D and 4 years of experience with older adults having complex care needs within the hospital system, case management, and service coordination. This experience includes entering, maintaining, and retrieving client information in electronic database systems. Preferences: Bachelor's degree or higher in Behavioral Sciences, Human Services, Social Work, Gerontology, Education, Communications, Public Administration or related and 5 years’ experience in working with older adults with disabilities Thorough knowledge of community resources and programs, to include health information privacy and benefited programs A well-organized person who can manage multiple priorities while meeting required deadlines and time-sensitive schedule Experience with researching and identifying community resources for clients, specifically those related to older adults and caregivers Experience building trust with clients to gather sensitive or complex information Bilingual Speaker - (English/Spanish) is a plus, but not required of applicant Special Requirements: Background Checks, which may include but are not limited to: Criminal History Check, Credit History Check, Education Verification Check, License Verification Check, and/or Fingerprinting may be required as posted in the job advertisement. Must pass criminal background check pursuant to VA Code Ann. 19-392-92 (2010) and the Older Americans Act of 1965 as amended in Section 701. Must pass DMV Record check Must possess a valid driver's license Mandated reporter of elder abuse Must have a physical and TB and be cleared for employment CPR/First Aid/AED Mandated contracted systems training Hiring Salary Range: $33.80-$40.00/ hourly Work Schedule: Part-Time, 20 Hours per Week.The regular work schedule will be established upon hire in consultation with the supervisor and based on agency needs. Work hours will be scheduled Monday through Friday between 8:00 a.m. and 5:00 p.m. The selected candidate must be able to attend required agency trainings and events. We also offer great benefits including: 401a and 457 retirement savings and investment plans Paid Annual Leave Paid Personal Leave Paid Sick Leave Paid Holidays Optional Group Medical, Dental, & Vision Plans An Employee Assistance Program (EAP) Career Development Opportunities NOTE: The above position description is intended to represent only the key areas of responsibilities; specific position assignments will vary depending on the business needs of the department. To view the class description in its entirety, Click here for the class description Prince William County is an Equal Opportunity Employer. In compliance with the Americans with Disabilities Act, the County will provide reasonable accommodations to qualified individuals with disabilities and encourages both prospective and current employees to discuss potential accommodations with the employer. SEE YOURSELF HERE! #J-18808-Ljbffr