Aftercare Coordinator

Parkland Community Health Plan; Dallas, Northern (TX, KY); Hybrid; USD 65,000 - 90,000; Full time

Job summary

Parkland Health in Dallas seeks an experienced Aftercare Coordinator to assess complex post-discharge needs and develop coordinated aftercare plans. You will work with families and the care team to ensure timely referrals, appointments, and resource access, while documenting outcomes and barriers.

The role emphasizes collaboration with care managers, providers, and community partners to optimize patient transitions and supports.

Qualifications

• Clinical license or certification required.
• 3 years direct patient care experience.
• Experience coordinating aftercare plans and services.

Responsibilities

• Assesses complex patient aftercare needs, risks, support systems, service eligibility, and barriers to successful care transitions.
• Develops individualized aftercare plans addressing follow-up treatment, medications, appointments, community resources, and education.
• Coordinates referrals, authorizations, appointments, and provider communication; ensures documentation within timelines.
• Interacts with patients, families, clinical teams, payers, and external agencies to resolve transition-of-care issues.
• Mentors and guides junior staff on aftercare practices and care-transition procedures.

Skills

Problem solving

Collaboration

Growth mindset

Execution

Digital literacy

Education

Bachelor’s of Science in Nursing

Bachelor’s degree in Physical Therapy

Bachelor’s degree in Occupational Therapy

Master’s degree in Speech-Language Pathology

Master’s Degree in Social Work

Job description

DAY SHIFT

Work Hours: 8am- 4:30pm (Monday- Friday) Employment Type: Full Time

Essential Functions

Assesses complex patient aftercare needs, risks, support systems, service eligibility, and potential barriers to successful care transitions. Assists in the management of aftercare programs, projects, workflows, caseload priorities, service resources, and performance-improvement activities. Develops more complex individualized aftercare plans that address follow-up treatment, medications, appointments, community resources, equipment, education, and support needs. Implements processes to coordinate referrals, authorizations, appointments, provider communication, patient outreach, and confirmation of required services. Ensures aftercare plans, referrals, interventions, patient communications, outcomes, and unresolved barriers are documented accurately and completed within established timeframes. Confers with patients, families, clinical teams, care managers, payers, community providers, and external agencies to coordinate services and resolve transition-of-care concerns. Interprets clinical information, treatment recommendations, eligibility requirements, coverage limitations, and available resources to guide aftercare decisions and recommendations. Coaches patients, families, and less-experienced team members regarding aftercare expectations, available resources, care-transition practices, and methods for addressing service barriers. Helps establish and implement aftercare procedures, educational materials, staff guidance, quality standards, and process improvements.

Level of Supervision Received

Plans and arranges own work; works with manager to prioritize projects.

Education Aftercare Coordinator

Required: Bachelor’s of Science in Nursing OR Bachelor’s degree in Physical Therapy from a school accredited by the American Physical Therapy Association OR Bachelor’s degree in Occupational Therapy from an accredited university OR Master’s degree in Speech - Language Pathology from an accredited university OR Master’s Degree in Social Work Work Experience Education can be substituted for experience. Required: 3 years Direct Patient Care Preferred: 1 years Burn unit experience

Knowledge, Skills, & Abilities

• Adept at problem solving and decision making skills|Medium|Required
• Adept at collaboration and teamwork|Low|Required
• Adept at growth mindset (agility and developing yourself and others) skills|Low|Required
• Adept at execution and delivery (planning, delivering, and supporting) skills|Low|Required
• Adept at digital literacy skills|Medium|Required

Licenses/Certification(s)/Registration(s)

Required/ Preferred: Must have current RN license or valid temporary permit with the Texas Board of Nursing or valid Compact RN license OR Must be licensed by the Texas State Board of Social Work OR Must have current licensure as a Physical Therapist with the Board of Physical Therapy Examiners for Texas OR Must be registered as an Occupational Therapist by the State of Texas OR Must be licensed by the Texas State Board of Examiners for Speech - Language Pathology and Audiology and have completed all requirements for a Certificate of Clinical Competence (CCC) issued by the American Speech and Hearing Association (ASHA). ABLS within 12 months of hire; BLS within 6 months of hire; Completes Phoenix Society SOAR Coordinator Course to facilitate the SOAR Program within 6 months of hire

Level of Responsibility Leadership & Talent

Typically responsible for providing guidance, coaching and training to other employees within job area.

Communication & Influence

Communicates information within and outside the job area on matters that involve obtaining or providing difficult or sensitive information requiring some explanation and interpretation for patients and others within the care team. Influences others within own job area and patients regarding policies, practices and procedures.

Organizational Impact

Executes clinical processes to solve difficult and sometimes complex problems to meet patient needs and/or deliver high-quality care to patients.

Knowledge & Experience

Requires clinical license and/or certification typically obtained through education and moderate to advanced practical knowledge of job area obtained through experience. Typically viewed as a specialist within discipline. Less than 2 years prior relevant

Problem Solving

Uses judgment based on the analysis of information.

Interpersonal Skills

Developed communication and diplomacy skills used to direct/persuade/influence others.

Project Management

Senior project/program team member responsible for work flow which is varied in nature with situations frequently requiring new solutions.

Parkland Health, one of the nation’s largest public hospital systems, is dedicated to delivering exceptional care to the Dallas community. A career at Parkland means joining a collaborative, engaged team focused on excellence, innovation, and patient-centered service. Our employees are supported with resources to grow, succeed, and make a meaningful impact every day.