Primary City/State:Phoenix, ArizonaDepartment Name:Case Mgmt-HospWork Shift:DayJob Category:Clinical CareHelp move health care into the future. At Banner Health we are changing health care to make the experience the best it can be. If that sounds like something you want to be part of, apply today.As a Transitional Care Associate, you will facilitate the safe and timely transition from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care program. You will also facilitate discharge plan for the transition of care and services into the designated setting or service. Additional responsibilities include providing on-site or telephonic discharge arrangements to post-acute and community services. You should be willing to work collaboratively with care coordination team members to identify any barriers to a safe discharge, and works with patient/family to provide clear communication regarding discharge plan.This is a full time opportunity. Hours are primarily Monday through Friday, 8AM to 4:30PM. Weekend rotations are required in this role. Enjoy a flat rate $3/hour weekend shift differential when applicable.University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics.POSITION SUMMARYThis position facilitates the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care or community program. Facilitates discharge plan for the transition of care and services into the designated setting or service. Provides on-site or telephonic discharge arrangements to post-acute and community services.CORE FUNCTIONS
Processes and facilitates the timely discharge/transfer of clients from hospital care to identified post-acute setting. Notifies care coordination team member(s) if patient or caregiver demonstrate or verbalize any inability/concern to be able to manage their post-acute plan or responsibilities.
Facilitates/ implements the care plan with proposed interventions in collaboration with healthcare team. Collaborates with all members of the healthcare team to implement, manage and communicate the transition of care arrangements.
Participates in performance improvement projects, Banner initiatives and performs data collection for measurement of projects as assigned.
Documents all interventions in the patient medical record both timely and accurately including all elements of the discharge plan. Performs transfer of accurate, pertinent patient information between all appropriate entities of the post-acute care continuum.
Assist and support patients and families in making appropriate arrangements for the post-acute plan. Performs follow-up calls to patients and providers as indicated and report any concerns to leadership.
Serves as an intermediary when providing community resources to patients, caregiver, and families. Discusses with patient, caregiver, and/or family maintaining clear communication regarding anticipated discharge date and potential care settings.
Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with transition of care planning and choices.
Employee has freedom to determine how to best accomplish functions within established procedures and implements the discharge plan under the delegated authority of a provider, licensed MSW, registered nurse or other licensed healthcare professional. Confers with supervisor/manager on any unusual situations and communicates plans and activities for patient discharge across the care continuum. Internal customers: Post-acute services team members and all levels of nursing management and staff, medical staff, and all other members of assigned facility interdisciplinary health care team. External customers: home health agencies, nursing homes, insurance providers, group homes, assisted living facilities, hospice, long-term acute care hospitals, inpatient rehabilitation facilities, volunteer agencies, county/governmental agencies and medical supply companies and others as required.
MINIMUM QUALIFICATIONSA Bachelor’s degree in social work or related degree or a Licensed Practice Nurse, or a Licensed Respiratory Therapist required.Must have knowledge of government/community agencies and resources, such as Medicare/Medicaid, long term care or other applicable resources/services. Must demonstrate effective communication and customer service skills, human relation skills and time management skills. Must be able to work flexible hours and work weekends on rotation. BLS required. (BLS is not required for employees working in the Insurance Division.)Employees working at BUMG, BUMCT, or BUMCS in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment. Employees working at the Banner Behavioral Health Hospital must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.PREFERRED QUALIFICATIONSPrevious experience in health care service setting, interacting with patients and families, usually obtained through work in social services, as a licensed practical nurse or in a discharge planning setting.Additional related education and/or experience preferred.EEO Statement:EEO/Female/Minority/Disability/Veterans (https://www.bannerhealth.com/careers/eeo)Our organization supports a drug-free work environment.Privacy Policy:Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)EOE/Female/Minority/Disability/VeteransBanner Health supports a drug-free work environment.Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability