Transitional Care Associate

Banner Health Corporate; Tucson (AZ); On-site; USD 52,000 - 73,000; Full time

Job summary

Banner Health is seeking a Transition Care Assistant to guide patients and families through discharge planning, coordinating post‑acute care from review of holdovers to rounds and care plan communication.

The role requires a Bachelor’s degree in social work or a related field, hospital healthcare experience, and strong communication & time-management skills. BLS certification is required.

Qualifications

• Bachelor’s degree in social work or related field.
• Experience in hospital or healthcare settings; knowledge of government/community resources such as Medicare/Medicaid and long‑term care.
• Effective communication, customer‑service, human‑relations, and time‑management skills.
• Ability to work flexible hours and weekends on rotation.
• BLS certification required (not required for employees in the Insurance Division).

Responsibilities

• Process and facilitate timely discharge/transfer of clients from hospital to identified post‑acute settings.
• Notify care coordination team if a patient or caregiver expresses inability or concern about managing post‑acute care.
• Implement and communicate the care plan with interventions in collaboration with the healthcare team.
• Participate in performance improvement projects and collect data for project measurement.
• Document all interventions and transfer accurate, pertinent information in the patient medical record.
• Assist and support patients and families in scheduling post‑acute arrangements; perform follow‑up calls as indicated and report concerns to leadership.
• Serve as an intermediary providing community resources to patients, caregivers, and families.
• Maintain knowledge of Medicare, Medicaid, and other program benefits to assist with transition planning.
• Determine how best to accomplish functions within established procedures and implement the discharge plan under delegated authority.

Education

Bachelor’s degree in social work or related field

Licensed Practical Nurse (LPN) or other licensed healthcare professional

Job description

We are 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 interdisciplinary team. In this vital role, you will guide patients and families through the discharge process from reviewing daily holdovers to attending multidisciplinary rounds, communicating discharge plans, and providing support at each step.

Position Summary

This position facilitates the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facilities, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice, and home or community programs. It involves planning and coordinating discharge to ensure appropriate post-acute care.

Core Functions

• Process and facilitate timely discharge/transfer of clients from hospital to identified post‑acute settings.
• Notify care coordination team if a patient or caregiver expresses inability or concern about managing post‑acute care.
• Implement and communicate the care plan with interventions in collaboration with the healthcare team.
• Participate in performance improvement projects and collect data for project measurement.
• Document all interventions and transfer accurate, pertinent information in the patient medical record.
• Assist and support patients and families in scheduling post‑acute arrangements; perform follow‑up calls as indicated and report concerns to leadership.
• Serve as an intermediary providing community resources to patients, caregivers, and families.
• Maintain knowledge of Medicare, Medicaid, and other program benefits to assist with transition planning.
• Determine how best to accomplish functions within established procedures and implement the discharge plan under delegated authority.

Schedule

This is a full‑time position with primary hours Sunday–Saturday, 10‑hour shifts. Weekend rotations are required. A flat rate of $3/hour is provided for weekend shift differential when applicable.

Minimum Qualifications

• Bachelor’s degree in social work or related field, or a Licensed Practice Nurse, Licensed Respiratory Therapist, or other licensed healthcare professional.
• Experience in hospital or healthcare settings; knowledge of government/community agencies and resources such as Medicare/Medicaid and long‑term care.
• Effective communication, customer‑service, human‑relations, and time‑management skills.
• Ability to work flexible hours and weekends on rotation.
• Basic Life Support (BLS) certification required (not required for employees in the Insurance Division).

Preferred Qualifications

• Previous experience in a health care service setting, interacting with patients and families, usually obtained through social services, licensed practical nursing, or a discharge‑planning setting.
• Additional related education and/or experience preferred.

EEO Statement

Banner Health is an equal opportunity employer. We encourage applications from all qualified individuals, including those who are veterans, people with disabilities, and others protected under federal and state law.