Transition of Care Intake Coordinator

Job Title: Transition of Care Intake Coordinator
Location: Primary Care Practice Group
Reports to: Care Coordination Manager / Office Manager

Job Overview:

We are seeking a dedicated and organized Transition of Care Intake Coordinator to join our Primary Care Practice Group. This role is essential for ensuring seamless care transitions for patients discharged from hospitals, skilled nursing facilities (SNFs), or other healthcare settings into our primary care system. The Transition of Care Intake Coordinator will work closely with patients, healthcare providers, and our clinical team to manage the intake process, ensuring continuity of care, proper documentation, and timely follow-up for all transitioning patients.

Key Responsibilities:

• Patient Intake and Information Management:
• Coordinate the intake process for patients transitioning from hospital settings, SNFs, or other care facilities into primary care services.
• Collect, verify, and enter all necessary demographic, insurance, and medical information into the system.
• Ensure accurate and timely completion of all required documentation related to the patient's transition of care.
• Care Coordination:
• Work closely with the care coordination team to schedule follow-up appointments and ensure timely medical evaluations for patients who are transitioning.
• Communicate with hospitals, SNFs, and other healthcare providers to gather relevant discharge information, including medical history, discharge plans, and follow-up care instructions.
• Provide patients with clear instructions regarding their next steps and care plan after discharge, ensuring they understand the importance of follow-up visits.
• Follow-up and Continuity of Care:
• Monitor and track patients for timely follow-up appointments and communicate with patients to confirm appointments and assist with any necessary scheduling adjustments.
• Collaborate with physicians and care teams to ensure that all post-discharge instructions and medications are clear and followed by patients.
• Identify and address any gaps in care or potential barriers to successful transitions for patients.
• Communication and Patient Support:
• Serve as the primary point of contact for patients during the transition of care process, addressing concerns, answering questions, and offering support.
• Ensure patients are educated on their follow-up care and medication management, assisting with coordination of home health or other services as necessary.
• Provide empathetic and supportive communication with patients and their families to facilitate a smooth transition.
• Data Management and Reporting:
• Maintain accurate records and documentation of all transition of care activities, including patient contact, follow-up, and care coordination efforts.
• Compliance and Regulatory Requirements:
• Ensure compliance with all healthcare regulations, including HIPAA, patient privacy, and documentation standards.
• Stay updated on relevant changes in regulations, including transition of care protocols and quality measures.

Qualifications:

• Education and Experience:
• High school diploma or equivalent.
• Minimum of 1-2 years of experience in a healthcare setting, with a focus on care coordination, patient intake, or transition of care management.
• Knowledge of healthcare systems, discharge planning, and post-acute care services is preferred.
• Skills and Abilities:
• Strong communication skills with the ability to interact effectively with patients, families, and interdisciplinary teams.
• Detail-oriented with strong organizational and time management skills.
• Ability to manage multiple tasks and prioritize effectively in a fast-paced environment.
• Proficient in the use of healthcare management systems, Electronic Health Records (EHR), and Microsoft Office Suite.
• Empathy and understanding of patients' needs during care transitions.

Physical Requirements:

• Ability to sit for extended periods of time while performing office tasks.
• Ability to use a computer, telephone, and other office equipment.

Benefits:

• Competitive salary and benefits package - Pay based on experience
• Health insurance, dental, and vision coverage.
• Paid time off and holiday pay.
• Professional development opportunities.

Job Type: Full-time

Expected hours: 40 per week

Benefits:

• Dental insurance
• Health insurance
• Life insurance
• Paid time off
• Vision insurance

Schedule:

• 8 hour shift
• Monday to Friday

Work Location: In person