Transitional Care Associate

bannerhealth; Sun City CDP (AZ); On-site; USD 42,000 - 60,000; Full time

Job summary

Banner Health in Sun City, AZ seeks a Transition Care Assistant with a Bachelor's degree to guide patients and families through the discharge process. You will review daily holdovers and participate in multidisciplinary rounds with physicians, nurses, nutritionists, and pharmacists.

The role supports post-acute planning across care settings, documents interventions, and communicates discharge plans. This full-time position offers growth within Banner Health.

Qualifications

• Bachelor's degree in a healthcare field or social work background.
• Experience in hospital/healthcare settings preferred.
• Ability to communicate discharge plans clearly to patients and families.

Responsibilities

• Facilitates timely discharge/transfer to post-acute settings.
• Collaborates with healthcare team to implement transition plans.
• Documents discharge interventions in the chart and coordinates follow-up.
• Engages with patients and families to arrange post-acute care needs.
• Maintains knowledge of program benefits and community resources.
• Participates in interdisciplinary rounds and care coordination workflow.

Skills

Discharge planning

Care coordination

Patient communication

Interdisciplinary rounds

Education

Bachelor's degree

Job description

Primary City/State:

Sun City, Arizona

Department Name:

Case Mgmt-Hosp

Work Shift:

Day

Job Category:

Clinical Care

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of.

Are you passionate about making a meaningful difference in patients' lives? We're seeking a dedicated Transition Care Assistant with a' Bachelor's Degree and experience in hospital/healthcare settings or a social work background to join our collaborative interdisciplinary team. In this vital role, you'll guide patients and families through the discharge process-from reviewing daily holdovers and attending multidisciplinary rounds with physicians, nurses, nutritionists, and pharmacists, to communicating discharge plans and providing crucial support every step of the way. As a valued team member, you'll experience the rewarding impact of direct patient interaction while building a strong foundation for professional growth in healthcare. If you thrive in fast-paced, engaging environments where your contributions truly matter and collaboration drives success, this is your opportunity to advance your career while making a real difference in patient care!

SCHEDULE:

This is a full time opportunity. Hours are primarily Sunday-Saturday, 10 hour shifts. Weekend rotations are required in this role. Enjoy a flat rate $3/hour weekend shift differential when applicable.

LOCATION

Banner Del Webb Medical Center -

Banner Boswell Medical Center has provided exceptional health care to the communities in the northwest area of metro-Phoenix for over five decades. Today, our 410-bed acute-care hospital is nationally recognized by U.S. News and World Report as one of Arizona's Best Hospitals. Banner Boswell offers a full range of acute care services, including cardiology, vascular, thoracic, oncology, orthopedics, neurology, general surgery, robotic surgery, rehabilitation, emergency, stroke, intensive care, pulmonary, urology, and inpatient wound management. We've earned the Society of Thoracic Surgeons highest quality award for CABG & aortic valve replacement and the Joint Commission's Advanced Certification as a Primary Stroke Center.

POSITION SUMMARY

This position facilitates the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care or community program. Facilitates discharge plan for the transition of care and services into the designated setting or service. Provides on-site or telephonic discharge arrangements to post-acute and community services.

CORE FUNCTIONS

• Processes and facilitates the timely discharge/transfer of clients from hospital care to identified post-acute setting. Notifies care coordination team member(s) if patient or caregiver demonstrate or verbalize any inability/concern to be able to manage their post-acute plan or responsibilities.
• Facilitates/ implements the care plan with proposed interventions in collaboration with healthcare team. Collaborates with all members of the healthcare team to implement, manage and communicate the transition of care arrangements.
• Participates in performance improvement projects, Banner initiatives and performs data collection for measurement of projects as assigned.
• Documents all interventions in the patient medical record both timely and accurately including all elements of the discharge plan. Performs transfer of accurate, pertinent patient information between all appropriate entities of the post-acute care continuum.
• Assist and support patients and families in making appropriate arrangements for the post-acute plan. Performs follow-up calls to patients and providers as indicated and report any concerns to leadership.
• Serves as an intermediary when providing community resources to patients, caregiver, and families. Discusses with patient, caregiver, and/or family maintaining clear communication regarding anticipated discharge date and potential care settings.
• Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with transition of care planning and choices.
• Employee has freedom to determine how to best accomplish functions within established procedures and implements the discharge plan under the delegated authority of a provider, licensed MSW, registered nurse or other licensed healthcare professional. Confers with supervisor/manager on any unusual situations and communicates plans and activities for patient discharge across the care continuum. Internal customers: Post-acute services team members and all levels of nursing management and staff, medical staff, and all other members of assigned facility interdisciplinary health care team. External customer