Healthcare Transitions Coach I - Chicago, United States - Professional Management Enterprises

Description

Seeking a Transitions Coach (RN or LSW, LCPC, OR LCSW) to be responsible for safely and effectively transitioning members from acute or inpatient care to lower levels of care in a cost-efficient manner.

This position is fully remote but requires candidates to reside in the surrounding counties of Cook, Lake, Dupage, Mchenry or Kane.

Work schedule is M-F 8am-5pm CST.


Summary:
Provides assessment, planning, implementation, coordination, monitoring, and evaluation of services for members as they transition care. Conducts an onsite or telephonic hospital discharge visit and post-discharge visit. Refers complex cases to case management as appropriate based on consultation with the Interdisciplinary Team.


Knowledge/Skills/Abilities:
Ability to independently use resources to solve problems. Skilled at identification and elimination of barriers to receiving services. Broad knowledge of area community resources/agencies. Ability to develop and execute plans of care and prepare reports as needed or requested. Knowledge of applicable state, federal and third-party regulations, and standards (Medicare, Medicaid, Copes, MPC, SSI). Comfortable working with Aged, Blind, Disabled, and Severely Mentally Ill populations with varied economic and educational circumstances.


Required Education:
BSN in Nursing or Social Services.


Required Experience: 2 years Medical Case Management experience. 2 years Public Health experience. Knowledge or experience using the Care Transitions Intervention or similar model. Background in discharge planning and home health. Computer and Microsoft Office experience


Required Licensure/Certification: Active, unrestricted State Registered Nursing license in good standing or LSW