Transitional Care Coordinator
Residential Home Health and Hospice Troy, MichiganLocation Troy, Michigan
Company Residential Home Health and Hospice
Job Type Full time
Date posted 01/27/2025
Job Description
SUMMARY: The Transitional Care Coordinator is a position with a number of important responsibilities that impact the delivery of care and patient outcomes. The Transitional Care Coordinator is the primary interface to the Agency’s referrals sources such as rehab centers, nursing homes, assisted living facilities and Acute Care Settings. This role is responsible for obtaining complete and accurate information from the patient’s medical record upon request for our skilled home health care service.
ESSENTIAL DUTIES AND RESPONSIBILITIES include the following. Other duties may be assigned as necessary.
• Responsible for obtaining complete/accurate demographic information, medical history, progress notes, including diagnosis for care and primary care physician information.
• Responsible for introducing Residential Home Health to the patient/caregiver, explaining scope of our services, skilled services requested and coordinating start of care visit.
• Patient education at bedside, arranging post discharge physician follow up appointments, sharing important discharge information with the primary care physician.
• One (1) week follow up customer service call to patient/caregiver when necessary
• Assist in obtaining regulatory documentation as required.
• Serves as a liaison between company and the patients/caregivers.
• All other duties as assigned by supervisor.
QUALIFICATION REQUIREMENTS: To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and/or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• Demonstrates high skill set to work with varied groups and departments within the organization and with partners
• Displays a high level of professionalism by exercising appropriate communication, patience, flexibility and a cooperative attitude
• Able to provide excellent customer service
• Effectively manages concurrent demands and multi-tasks to completion during the assigned shift
• Detail orientated to manage complex situations and meet regulatory requirements
• Maintains a consistent professional attitude with referral partners and patients
EDUCATION and/or EXPERIENCE:
• Associate Degree required, Bachelor Degree preferred
• One (1) year of experience in home health preferred
CERTIFICATES, LICENSES, REGISTRATIONS: Must have and maintain in good standing professional license, certificate or registration.
PHYSICAL DEMANDS: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, climb stairs, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.
The employee frequently lifts and/or moves up to 20 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.
WORK ENVIRONMENT: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this position, the employee travels by automobile and is exposed to changing weather conditions. Employee will be required to drive daily for meetings and/or visits to residential homes. Employee will work in varied residential environments based on assigned caseload.
NOTICE: Successful completion of a drug screen prior to employment is part of our background process, which includes medical and recreational marijuana.
By supplying your phone number, you agree to receive communication via phone or text.
By submitting your application, you are confirming that you are legally authorized to work in the United States.
JR# JR244777
Jennifer Quinones Hospice Nurse
"The support from staff, supervisors, and Medical Directors is great. The education is top notch, too. They always want to give us more, so we can be the best there is. I tell people I can't believe how much time I wasted before coming to work here!"
Wendy Bongero Sr. Vice President of Operations, Hospice
“Leaders who don’t listen to the people on their teams are blowing a huge opportunity. No one knows better than the clinicians what our patients need.”
Carrie Dodge Sales
Residential’s positive culture has given me the confidence to expand my skill set and grow in my career.