Care Transition Coordinator: Drive Seamless Transitions

BrightSpring Health Services Corporation; Wheeling (WV); On-site; USD 60,000 - 78,000; Full time

Job summary

Adoration Health in Wheeling, WV is seeking a Care Transition Coordinator to facilitate patient transitions from facilities to home health or hospice. You will evaluate eligibility, coordinate care plans, and arrange DME and infusion in line with agency protocols and patient needs.

You will act as a liaison among the agency, referral sources and healthcare providers, ensuring timely communication, documentation and education.

Qualifications

• Minimum of one year of experience in home health or hospital-based case management.
• One to three years in medical marketing or healthcare business development.
• Current and active licensure in the state as RN, LPN, SW, or PT.
• Respiratory Therapist certification and/or clinical program preferred.
• Must have a valid driver's license, reliable transportation, and current auto insurance.
• Understanding of home health eligibility criteria and Medicare guidelines.

Responsibilities

• Achieve monthly personal production goals and MC admission targets for assigned locations.
• Manage sales and marketing expenses to ensure financial stewardship and ROI.
• Implement strategies to increase market share within assigned facilities.
• Evaluate patients and orders for home care eligibility per Right of Choice guidelines.
• Conduct face-to-face transitions to educate patients and identify the primary care physician.
• Present needs to the Executive Director to obtain branch approval and complete encounters in Home Care Home Base.
• Coordinate transfer orders and ancillary services after patient acceptance.
• Educate patients on home care or hospice orders and services from referrals.
• Ensure referral-derived patient needs are documented and addressed on acceptance.
• Collaborate with leadership to grow by aligning with referral sources and patient needs.
• Perform sales admin duties like BOA expense entry, PTO requests, and attendance at meetings.
• Educate patients on post-discharge appointments, prescriptions, and medication management.
• Act as liaison between agency and providers for new referrals and transfers.
• Notify discharge planning of active patients transferred from home health to a facility.
• Coordinate resumption of care when orders are obtained.
• Provide follow-up feedback to case management on readmission status.
• Maintain patient confidentiality per laws and policies.
• Demonstrate knowledge of services, programs, and Medicare guidelines; educate professionals with tools.

Skills

Home health experience

Case management

Medical marketing

RN/LPN/SW/PT licensure

Driver's license

Medicare guidelines knowledge

Job description

Adoration Health in Wheeling, WV is seeking a Care Transition Coordinator to facilitate patient transitions from facilities to home health or hospice. You will evaluate eligibility, coordinate care plans, and arrange DME and infusion in line with agency protocols and patient needs.

You will act as a liaison among the agency, referral sources and healthcare providers, ensuring timely communication, documentation and education.