Care Transitions Navigator

Independent Living Systems, llc; Tampa (FL); Presencial; USD 55.000 - 75.000; Jornada completa

Descripción de la vacante

Independent Living Systems, llc is hiring a Care Transitions Coordinator in Tampa, FL. The role focuses on coordinating member transitions from nursing facilities to community settings, developing individualized transition plans, and collaborating with care teams to ensure safe, timely care transitions.

You will work with hospitals, facilities, and community resources to support safety and adherence to care plans, aiming to reduce avoidable readmissions and improve health outcomes.

Formación

• Bachelor’s degree in social work, sociology, psychology, gerontology, or related social services field.
• Bachelor's degree in a field other than social science.
• Strong knowledge of healthcare systems, discharge planning, and community resources.

Responsabilidades

• Coordinate individualized transition plans with care management teams and families.
• Communicate with hospitals, nursing facilities, and community resources to ensure safe transitions.
• Monitor progress after discharge to reduce readmissions and adverse outcomes.
• Arrange post-discharge services, equipment, medications, transportation, and follow-up appointments.
• Educate members and families about discharge instructions and self-management.
• Identify and resolve barriers to successful transitions, including housing and access to services.
• Maintain accurate documentation of transition activities and outcomes.

Conocimientos

Communication skills

Interpersonal skills

EHR proficiency

Basic computer skills

Healthcare systems knowledge

Educación

Bachelor's degree in social work / sociology / psychology / gerontology

Bachelor's degree in other field

Master's degree in social work / public health

CCM certification

RN license (FL)

LPN license (FL)

Herramientas

EHR systems

Descripción del empleo

Independent Living Systems, llc is hiring a Care Transitions Coordinator in Tampa, FL. The role focuses on coordinating member transitions from nursing facilities to community settings, developing individualized transition plans, and collaborating with care teams to ensure safe, timely care transitions.

You will work with hospitals, facilities, and community resources to support safety and adherence to care plans, aiming to reduce avoidable readmissions and improve health outcomes.