Transition Coach

• provides support to a group of patients who have recently discharged home from the emergency room with the goal of reducing readmissions and increasing self-management skills in the community during the first 30 days of discharge
• conducting home visits
• provide follow up calls to each patient to offer additional support services as needed
• connect the patient to community resources
• review recommendations from the in-person visit
• ensure effective communication across the team to support a smooth discharge home

• Bachelor’s Degree preferred, experience may be substituted
• excellent verbal and written communication skills
• ability to independently organize work and meet deadlines
• ability to work with an interdisciplinary team across multiple agencies to effectively prioritize and address referrals
• ability to complete thorough assessments and identify appropriate home and community-based services and resources to meet needs
• experience with discharge planning, case management, care coordination, and/or providing referrals and resources, preferred
• a reliable car, current driver’s license and safe driving record is required

experience with discharge planning, case management, care coordination, and/or providing referrals and resources

• 3 weeks of vacation in first year
• Birthday off
• 13 paid holidays
• 3 paid personal days
• 15 paid sick days per year (You can accumulate up to 450hrs/12weeks)
• Health & dental insurance with employer contribution
• Life and long-term disability insurance at no cost to employee
• Flexible Spending Plan
• Employee Assistance Plan
• 401K Retirement Savings Plan w/ employer contribution
• Mileage reimbursement
• Flexible Work Options available after 6 months for most positions
• alternate start time between 8:00 and 9:30 a.m., 4-day work week, 4.5-day work week, telecommuting work option, remote work option
• Employee referral bonuses
• Free parking
• Commitment to promoting from within