Job Summary:
The Care Transition Coordinator will work in a variety of outreach settings (including emergency room, outpatient departments and inpatient nursing units) to provide care management for frequent utilizers of DMH services with a variety of complex health care needs. Upon identification, the Clinical Transition Coordinator will assist these patients in breaking the cycle of ED visits or hospitalizations by coordinating immediate follow-up care needs and on-going resources to prevent returns to the facility for services that could be provided in an alternate setting.
The Clinical Transition Coordinator also shares the responsibility for retrospective review, abstraction and data submission needed to assure hospital-wide compliance with inpatient quality reporting requirements, inpatient psychiatric reporting and outpatient. The role involves extensive work getting information from Meditech, and chart review as well as direct communication with clinicians. It includes data entry, maintenance of spreadsheets and reports, and participation in quality improvement activities as assigned.
The coordinator must be able to develop and maintain effective interpersonal relations, maintain confidentiality of all data, information, and activities, and be able to perform detailed, concentrated work with limited supervision.
The coordinator must be flexible and willing to adapt to changes in workload/assignments depending on the organization’s needs.
Minimum Knowledge, Skills, Experience Required:
Graduate of an accredited school of nursing: BSN Preferred
Minimum 3 years nursing experience in an acute care facility; knowledge of hospital systems and procedures preferred. Experience in Quality, Case Management and/or Lean Six Sigma is plus.
Moderate to advanced computer skills, including the use of Microsoft Office (Word, Excel, PowerPoint). Ability to develop, maintain spreadsheets and databases as required to perform quality outcome duties.
Able to communicate effectively both verbally and in writing.
Able to comprehend complex clinical data.
Able to organize, prioritize and manage time efficiently to meet deadlines.
License/Certification:
Required: Current Alabama RN License