Care Coordination & Transitions of Care Specialist

BayCare Health System; Tallahassee (FL); Sur place; USD 32 000 - 47 000; Plein temps

Résumé du poste

BayCare Health System seeks a Care Coordination Specialist to join our interdisciplinary team in South Florida. The role focuses on comprehensive care coordination and discharge planning to optimize patients’ clinical and financial outcomes within a value-based care model.

The position involves assessing barriers to transitions of care, coordinating referrals, and linking patients to community resources to support effective post-acute care and avoid readmissions.

Qualifications

• Bachelor's degree in social work, psychology, or healthcare related field OR LPN License.
• Medical Social Work or LPN experience preferred.

Responsabilités

• Function as a key member of an interdisciplinary, value-based care delivery model to optimize clinical, quality, and financial outcomes.
• Provide comprehensive care coordination and discharge planning to ensure appropriate post-acute resource utilization, reduce readmissions, and support risk stratification.
• Identify and address barriers to transitions of care, including social determinants of health, to improve outcomes and reimbursement.
• Coordinate transition of care activities, including referrals, post-acute authorizations if needed, transportation needs, and linkage to community resources.

Formation

Bachelor's degree in social work, psychology, or healthcare related field OR LPN License

Description du poste

BayCare Health System seeks a Care Coordination Specialist to join our interdisciplinary team in South Florida. The role focuses on comprehensive care coordination and discharge planning to optimize patients’ clinical and financial outcomes within a value-based care model.

The position involves assessing barriers to transitions of care, coordinating referrals, and linking patients to community resources to support effective post-acute care and avoid readmissions.