Care Transition Specialist

Parkland Health and Hospital System (PHHS); Dallas (TX); On-site; USD 60,000 - 90,000; Full time

Job summary

Parkland Health and Hospital System in Dallas is seeking an Aftercare Coordinator to assess complex patient aftercare needs and coordinate continued care after discharge. You will develop plans addressing follow-up treatments, medications, appointments, community resources, and education.

The role emphasizes coordination with clinical teams, payers, and external agencies, ensuring documentation accuracy and timely service delivery while guiding families through aftercare processes.

Qualifications

• Current licensure as RN, OT, PT, or SLP per listed options.
• Eligibility for licensure in Texas for each applicable role.
• Experience coordinating patient aftercare and transitions.

Responsibilities

• Assesses complex aftercare needs and barriers to care transitions.
• Coordinates referrals, authorizations, and appointments across teams.
• Develops individualized aftercare plans with follow-up care and resources.
• Documents outcomes and barriers within established timeframes.
• Collaborates with patients, families, and care teams to resolve concerns.

Skills

Problem solving

Collaboration

Growth mindset

Execution delivery

Digital literacy

Education

RN license

BSN or higher

PT license

OT license

SLP CCC

SW license

Job description

Parkland Health and Hospital System in Dallas is seeking an Aftercare Coordinator to assess complex patient aftercare needs and coordinate continued care after discharge. You will develop plans addressing follow-up treatments, medications, appointments, community resources, and education.

The role emphasizes coordination with clinical teams, payers, and external agencies, ensuring documentation accuracy and timely service delivery while guiding families through aftercare processes.