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The National Healthcare Group Corporate Office (HQ) is seeking a Care Transition Coordinator to act as a bridge between acute hospitals and community care settings, ensuring discharged patients are placed appropriately in primary care facilities.
You will identify suitable patients, enroll them with primary care providers, coordinate seamless transfers, and maintain repositories of community healthcare resources.
The Care Transition Coordinator serves as a vital bridge between acute hospitals and community care settings, working to ensure discharged patients from inpatient wards, outpatient clinics, and Emergency Departments are appropriately placed in primary or community care facilities such as General Practioners, Family Medicine Centres and Polyclinics.
This role involves collaborating with clinicians and clinic managers to identify suitable patients for community placement, enrolling them with primary care providers, facilitating seamless care transfers in both directions when necessary, and maintaining comprehensive repositories of community healthcare resources.
The coordinator also works extensively with various healthcare stakeholders including Specialist Outpatient Clinics, Community Health Teams, NHG Population Health and Ministry of Health to produce regular administrative reports on patient indicators, whilst providing patients with essential information and serving as the key liaison for accessing available primary and community care resources.