Home-Based Transitional Care Specialist

Your Health; Ladson, Northern (SC, KY); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Bonus opportunities

401K matching

HDHP insurance plan with prescriptive/

HSA

Generous PTO

Vehicle allowance

Job summary

Your Health in Charleston, SC is seeking a Transitional Care Professional to act as a clinical liaison for our patients throughout the Charleston area. The role coordinates care during transitions from hospitals, rehab centers, and SNFs back home, aiming to improve patient experience and reduce readmissions.

Responsibilities include home and facility visits, arranging home health and follow-up care, coordinating with care teams, and providing compassionate, patient-centered service.

Qualifications

• Certified Medical Assistant, Paramedic, or Licensed Nurse preferred.
• Previous public health or home health experience preferred.
• Minimum of three years clinical experience preferred.
• Ability to read and communicate effectively.
• Strong organizational and time management skills; multitask capability.
• Basic computer knowledge.
• Strong interpersonal and communication skills under all conditions.
• Must be a licensed driver with a reliable, insured vehicle.

Responsibilities

• Visit referrals and established patients within assigned facilities and in-home/ALF/ILF settings.
• Establish trust and rapport with patients to aid informed health decisions during facility stays.
• Provide guidance based on care team recommendations.
• Coordinate seamless transitions home by arranging home health, outpatient rehab, and follow-up care.
• Schedule essential visits with primary care, virtual provider, specialists, pharmacists, social workers, etc.
• Facilitate communication among healthcare professionals involved in the patient’s care.
• Ensure adherence to the plan of care by patients and families.
• Interact with patients via phone, email, portals, or in person to gather information and address concerns.

Skills

Certified Medical Assistant

Paramedic

Licensed Nurse

Strong written and verbal skills

Basic computer knowledge

Effective communication

Leadership skills

Driver with insured vehicle

Job description

Your Health in Charleston, SC is seeking a Transitional Care Professional to act as a clinical liaison for our patients throughout the Charleston area. The role coordinates care during transitions from hospitals, rehab centers, and SNFs back home, aiming to improve patient experience and reduce readmissions.

Responsibilities include home and facility visits, arranging home health and follow-up care, coordinating with care teams, and providing compassionate, patient-centered service.