Care Transition Specialist

SANITAS OF TEXAS LLC; Katy (TX); Sur place; USD 52 000 - 72 000; Plein temps

Résumé du poste

Sanitas of Texas LLC is seeking a Case Management Coordinator to manage post-discharge transitions and chronic care coordination. You will develop personalized care plans, educate patients and caregivers, and work with primary care teams to prevent readmissions and improve outcomes.

The role emphasizes strong documentation, motivational interviewing, and collaboration with healthcare partners to ensure seamless care across the continuum.

Qualifications

• Post-discharge outreach within 24–72 hours to assess needs and gaps in care.
• Coordinate follow-up appointments with providers and community resources.
• Educate members and caregivers using motivational interviewing.
• Document all interactions in care management platform in a timely, compliant manner.

Responsabilités

• Manage transition of care for post-discharge and chronic conditions.
• Develop individualized care plans and escalate clinical issues as needed.
• Collaborate with primary care, specialists, and community resources to ensure continuity of care.

Connaissances

Motivational interviewing

Patient engagement

Communication

Clinical problem-solving

EMR documentation

Formation

High school diploma or equivalent

Graduate of an accredited Medical Assistant program

CCM credential (preferred)

Outils

EMR systems

Care management platform

Description du poste

Sanitas of Texas LLC is seeking a Case Management Coordinator to manage post-discharge transitions and chronic care coordination. You will develop personalized care plans, educate patients and caregivers, and work with primary care teams to prevent readmissions and improve outcomes.

The role emphasizes strong documentation, motivational interviewing, and collaboration with healthcare partners to ensure seamless care across the continuum.