Job Information
Trinity Health Care Transitions Coordinator - Health Homes in Troy, New York
Employment Type:
Full time
Shift:
Day Shift
Description:
Care Transitions Coordinator - Health Homes
We are looking for an energetic individual to join our Team! The ideal candidate will be someone who exercises compassion and dedication to serving the vulnerable members of our community. The Care Transitions Coordinator is responsible for acting as a bridge between health care providers, social care providers and individuals in the community to promote health, reduce disparities and improve service delivery. Supporting individuals as they transition across the care continuum strengthens the connection with their providers and resources, which ultimately helps them to reach their potential. This includes the promotion of preventative care to reduce preventable emergency room and inpatient utilization, as well as an opportunity to address any social influencers of health.
Position Summary:
The Care Transitions Coordinator will develop a professional and trusting relationship with patients and community providers to continually improve the quality and continuity of care, as well as reduce inpatient hospital readmission and emergency room utilization. This is accomplished by providing community visits to patients discharged from the Inpatient Behavioral Health Unit or Crisis Unit at Samaritan Hospital and employing an empowerment approach in coordination with health and social care providers. This "bridge" from the hospital to the community ensures a warm handoff and allows for any barriers to be addressed in real time. The goal of the community-based visit is to review the discharge instructions with the patient, repeat the “teach back” information protocol, identify any barriers to following the discharge plan (to include follow up appointments, prescriptions, transportation to appointments, etc.) and ensure that the patient attends necessary follows up visits. Time is split between working in the community conducting visits, working in the hospital and local shelter.The aim is to assist the patients in reaching optimal wellness and recovery.
Education & Experience Requirements:
Bachelor's degree in Human Services, or related field, required.
Minimum of two years or more working with individuals with behavioral health issues.
Job Requirements:
Extensive planning, organizational skills, and excellent communication with collateral contacts, referral and networking.
Ability to interview patients to assess decision making, coping skills, and barriers to managing their healthcare needs.
Adhere to policies and procedures as developed by the director of the department.
Be comfortable working with individuals actively experiencing behavioral health symptoms.
Must be able to work closely with others and work with members in both routine and stressful situations related to their diagnoses and social influencers of health.
Ability to work independently, setting priorities to coordinate care plan efficiently. As well as the ability to work in a team environment.
Requires the ability to drive, must possess a valid driver’s license.
Effective behavioral and educational strategies, including but not limited to, motivational interviewing, teach-back method and self-management support.
A working knowledge of entitlement programs (SSI, SSDI, Medicare, Medicaid, and Public Assistance) and community resources strongly preferred.
Strong Computer Literacy.
Prior experience with care management/coordination is preferred.
Pay Range: $20.25 - $28.15
Pay is based on experience, skills, and education. Exempt positions under the Fair Labor Standards Act (FLSA) will be paid within the base salary equivalent of the stated hourly rates. The pay range may also vary within the stated range based on location.
Our Commitment to Diversity and Inclusion
Trinity Health is one of the largest not-for-profit, Catholic healthcare systems in the nation. Built on the foundation of our Mission and Core Values, we integrate diversity, equity, and inclusion in all that we do. Our colleagues have different lived experiences, customs, abilities, and talents. Together, we become our best selves. A diverse and inclusive workforce provides the most accessible and equitable care for those we serve. Trinity Health is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, status as a protected veteran, or any other status protected by law.
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
EOE including disability/veteran