Transition Coach - Population Health Care Management Job at WellSpan Health
This is a fully remote position, but may require occasional travel within the Wellspan footprint.
Schedule and Location
FT: Days/Evenings. Alternating Weekends.
3550 Concord Road, York, PA 17402
Job Description
Under the general supervision of the Population Health Care Management team leadership, provides transition coaching services to patients. Functions as a facilitator of care continuity across care settings, coaching the patient and caregiver to play an active and informed role in care plan execution. Helps patients manage their chronic diseases. Assists in the care of patients, and instructs patients and their families in appropriate care, as directed by their provider. Focuses on skill transfer beginning during the home visit and continuing throughout the 30-day relationship. The Transition Coach provides practice and guidance to the patient/caregiver for effective care transitions, improved self-management skills and enhanced patient-practitioner communication.
Duties and Responsibilities
- Provides support to patients during the transition of care via appointment coordination and navigation of the health system.
- Communicates and shares information with providers and the Ambulatory CCT members on issues and concerns such as transition of care between hospital, skilled nursing facility, rehab and home care.
- Refers to appropriate care management service for longer term coaching and support utilizing the established referral processes.
- Addresses and mitigates patient social determinants of health needs that could negatively impact care plan follow through.
- Uses Motivational Interviewing techniques to engage patients in self-management skills.
- Assists patients with instruction and health literacy through teach back of any new medications, transition instructions and equipment. Provides health care information materials and reviews with patient and or family members as directed by providers.
- Maintains the patient’s records to ensure an accuracy of the patient’s medical treatment. Documents in the patient record under the direction and supervision of the care provider.
Qualifications
- Minimum Experience:
- 1 - 2 years
- Experience Educating patients with Chronic conditions preferred.
- Minimum Education:
- Post High School Vocational/Specialized Training
- Required Certification:
- Current LPN license in PA; Basic Life Support (BLS) certification
- Req Courses/TrainingCompletes all required education programs and competency testing needed to perform at an advanced level; medical terminology
Please Note :
www.bankofmontserrat.ms is the go-to platform for job seekers looking for the best job postings from around the web. With a focus on quality, the platform guarantees that all job postings are from reliable sources and are up-to-date. It also offers a variety of tools to help users find the perfect job for them, such as searching by location and filtering by industry. Furthermore, www.bankofmontserrat.ms provides helpful resources like resume tips and career advice to give job seekers an edge in their search. With its commitment to quality and user-friendliness, Site.com is the ideal place to find your next job.