GENERAL SUMMARY/OVERVIEW
The Care Transition Specialist completes administrative responsibilities related to care progression and care transitions along the continuum of care. They work collaboratively with nurse care coordinators, social workers, physicians, and other care team members. The Care Transition Specialist is responsible for acting as an advocate for patients and patient families and strives to support Brigham Health's aim for high quality care, high customer satisfaction, and optimal resource management.
Brigham and Women's Hospital is an Affirmative Action Employer. By embracing diverse skills, perspectives and ideas, we choose to lead. All qualified applicants will receive consideration for employment without regard to race, color, religious creed, national origin, sex, age, gender identity, disability, sexual orientation, military service, genetic information, and/or other status protected under law. We will ensure that all individuals with a disability are provided a reasonable accommodation to participate in the job application or interview process, to perform essential job functions, and to receive other benefits and privileges of employment.
1. Provides direct administrative support to the care team, patients, and patients' caregivers
a. Support the administrative tasks and communication related to post discharge care (e.g., the 4Next process, faxing to long term care facilities, follow-up appointments, etc.)
b. Performs administrative tasks to support the ordering of equipment, completion of forms, and medication authorizations
c. Distributes key forms and documents to comply with regulations (e.g., MOON, IM, etc)
d. Arranges all types of patient transportation under the direction of the care team
e. Participates in family meetings and interdisciplinary huddles to solicit and provide input related to their responsibilities
f. Completes administrative documentation under the direction of the care team
2. Collects, confirms and verifies key patient information (i.e., demographics, health care proxy, benefit verification, and patient preferences for pharmacy, VNA, etc).
3. Maintains knowledge and reference materials on key resources available to patients and patients' caregivers across the continuum
a. Acts as a knowledge resource for post acute care resources, included but not limited to, insurance requirements, facility attributes, contact information, etc.
b. Identifies and refers patients to community services (i.e. transportation, food programs, day programs, and financial programs)
c. Communicates, consults and collaborates with a wide range of social agencies, clinics, schools and courts under the direction of the care team
Working hours:
8:00am - 4:30pm
8:30am - 5:00pm
Weekend rotation
Qualifications
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