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| Job Ref: | 11-6405 |
| Industry: | Management |
| City: | Washington |
| State: | D.C. (DC) |
| Employer: | Amedisys |
| Post Date: | 04/15/2012 |
| Job Description: |
The Care Transitions Coordinator is a clinical liaison position between health care providers to ensure continuity of care for patients transitioning from a facility to home care or hospice environment. The position has two separate and distinct general responsibilities: (1) following the receipt of a valid referral for home health or hospice services, directly communicating with and assessing the patient to improve the patient’s transition from the inpatient to the home setting; and (2) developing the business and referral relationships of the agency within the community, in accordance with Amedisys policies and procedures. 1) After a patient has selected Amedisys as his or her post-hospital health care provider, the Care Transitions Coordinator visits the patient onsite to review the physician order, assess the patient’s clinical needs and gather clinical information from the hospital and the patient. The Care Transitions Coordinator uses a Point of Service computer application to collect referred patient data onsite and transmit it to the agency. The Care Transitions Coordinator also facilitates patient involvement in his or her own care by providing education and obtaining the necessary information required for successful transition to home using the Personal Health Record Document (see attached document). 2) The Care Transitions Coordinator is also responsible for establishing, growing and maintaining relationships with facility-based referral sources, in accordance with Company policies and procedures, by both communicating with existing referral sources and identifying new opportunities. Requirements 1. RN or LPN/LVN (with a current, active license in the state of service) *CB* |
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