What are the responsibilities and job description for the Transitions In Care Coach position at Greater Springfield Senior Services, Inc. (GSSSI)?
Full Time, 35 hours per week with excellent benefits package. THIS IS NOT A REMOTE POSITION.
Provides proactive telephonic and in-home outreach to eligible Blue Cross / Blue Shield Medicare Advantage members recently discharged from an emergency room within GSSSI's catchment area. The goal is to reduce the likelihood of hospital admissions or readmissions and to facilitate a smooth transition from hospital to home. The position will also be cross trained in the Family Caregiver Support Program to provide back-up case support.
Contacts member by phone or meets them in the hospital based on contract specifications, making attempts to ensure that each patient receives at least one in-home, in person visit within seven days of discharged or referral.
Conducts 2 - 3 follow-up phone calls to the patient within 30 days of the emergency room visit or admission, emphasizing the points discussed during previous conversations.
Utilize active listening skills and empathy to assess members' needs accurately and appropriately refer them to programs or services offered by GSSSI and other community agencies.
Participates in weekly meetings and rounds with clinical staff to discuss the status and progress of enrolled patients and actively participate in ongoing professional training and supervision.
Education and Experience :
At least 3 years of related field experience is required, and Bachelor's or associate degree in related field is preferred.
Knowledge of long term care and social service delivery systems, community resources, and local service systems for older adults and persons living with disabilities is required.
Reliable vehicle, including active vehicle insurance and acceptable driving record is required.
Job Posted by ApplicantPro
Salary : $29
