Heal at Home Coordinator

Description

Job Summary:

The Heal at Home Coordinator is responsible for managing and coordinating patient discharges from the hospital to home care services. This role ensures that patients are safely transitioned from the hospital environment to in-home care, facilitating communication between healthcare teams, patients, families, and home care providers. The coordinator works to ensure that patients receive the necessary post-discharge services, improving patient outcomes and reducing readmission rates.

Key Responsibilities:

• Patient Discharge Planning:
  • Collaborate with multidisciplinary teams, including physicians, nurses and social workers, to facilitate a smooth hospital discharge for patients enrolled in the Heal at Home program.
  • Coordinate patient needs for post-discharge care, including home health services, physical therapy, etc.
  • Ensure that patients and families are fully informed about the Heal at Home program.
• Coordination of Home Care Services:
  • Work with clinical care coordinators, patient care coordinators and area managers to arrange for the delivery of in-home care services, ensuring timely initiation upon discharge.
  • Communicate time of discharge with clinical care coordinators and others as appropriate.
  • Ensure that patients and caregivers receive proper education regarding the services they’ll receive.
• Patient and Family Education:
  • Provide clear, concise instructions to patients and families on care needs after discharge.
  • Educate patients and families about how to access home care services, follow-up appointments, and any needed equipment or supplies.
• Documentation and Communication:
  • Maintain accurate and up-to-date documentation of discharge plans, services arranged, and any relevant patient information.
  • Act as the liaison between hospital teams, home care providers, patients, and families to ensure seamless communication.
  • Track patient progress and outcomes, documenting follow-up calls, visits, and any issues encountered during the home care process.

• Quality Assurance and Improvement:
  • Monitor patient satisfaction and outcomes post-discharge, identifying any gaps in care or service delivery.
  • Work with hospital leadership and internal stakeholders to identify areas for improvement in discharge and home care coordination processes.
  • Participate in initiatives to reduce readmissions by ensuring the appropriate home care interventions are in place.
• Compliance and Best Practices:
  • Ensure compliance with healthcare regulations and policies related to patient discharge and home care services.
  • Stay informed on the latest developments in home health care and discharge planning best practices.

Qualifications

Qualifications:

• Education:
  • Bachelor’s degree in Nursing, Healthcare Administration, Social Work, or a related field.
  • Master’s degree in a healthcare related field (preferred)
  • Certification in case management or discharge planning (preferred).
• Experience:
  • Experience working with home health agencies and knowledge of home healthcare services and providers is preferred.
• Skills:
  • Strong organizational and multitasking skills with the ability to manage multiple patient discharge plans simultaneously.
  • Excellent communication and interpersonal skills to interact with patients, families, healthcare providers, and home care agencies.
  • Strong knowledge of healthcare systems, home care regulations, and insurance processes.
  • Proficient in healthcare-related software, electronic health records (EHR), and other related technology.

Working Conditions:

• Location: Hybrid
• Full-time position with occasional weekends or evenings required to meet patient needs.
• Occasional travel may be necessary.

Physical Requirements:

• Ability to work in a hospital and office environment, including standing and sitting for extended periods.

*Please note that this Job Summary and Essential Duties and Responsibilities as outlined are the general nature and level of work to be performed. It is not intended to be an exhaustive list of all responsibilities, duties and skills required of the employee.

*Please note that some benefits may only be available to full-time employees and/or certain employee classifications. Candidates must be able to pass a drug test and criminal background check. Interested applicants may apply in person or by replying to this ad.

EOE - We are committed to ensure fair and equal treatment for everyone we employ and are a proud Equal Opportunity Employer.

Salary : $41,888 - $57,330