Transitional Case Manager

Overview

We are hiring for a Transitional Case Manager/Discharge Case Manager at University of Maryland Capital Regional Medical Center. Salary Range: RN $80,000-$90,000 full-time annual or LPN $75,000-$80,000 full-time annual.

At VNA of Maryland, a part of LHC Group, we embrace a culture of caring, belonging, and trust and enjoy the meaningful connections that come from it: for the whole patient, their families, each other, and the communities we serve - it truly is all about helping people. You can find a home for your career here.

If you love nursing and want to strengthen your experience, this is a great opportunity for you. Apply today!

The Transitional Case Managers (TCM) primary responsibility is to facilitate a seamless transition for patients discharging from a facility setting to the care of an LHC Group agency for post-acute care needs. This includes understanding and implementing company market development initiatives and their role in growth as we focus on serving more patients and delivering exceptional care. The TCM will verify home health orders, assess the care required, and ensure continuity of care and the agency s ability to meet the needs of the patient.

The TCM will assess each patient to determine health literacy level and ensure patients and families are included in care planning. After identifying needs, the TCM will begin best practice intervention and education to improve patient outcomes and promote self-management. The TCM will implement rehospitalization reduction initiatives for patients at risk of Acute Care Hospitalization and will continually communicate between healthcare providers during all phases of transition from facility to home.

Identifies primary care physician to follow the plan of care.

• Educates patient on the importance of post-facility discharge follow-up with the physician
• Assess patient s risk for readmission using the LACE tool and documents in Transition encounter
• Educates patient on homebound criteria and verifies the patient meets these requirements
• Educates LHC Group referrals on Call First process and ensures patient and family have agency contact information
• Educates patient on obtaining all necessary prescriptions prior to discharge and confirms the patient s understanding of medication, pharmacy, and delivery method
• Coordinates other ancillary services for the patient (DME, Infusion) as needed
• Assists the LHC Group agency in preparation for accepting care of the patient post-discharge
• Serves as a liaison between the LHC Group agency and all involved healthcare providers of newly referred patients as well as existing patients transferred to the hospital from the home health agency
• Communicates discharge planning any active patients that transfer from home health into a facility and coordinates resumption of care with the patient prior to discharge if applicable orders are obtained
• Provides follow-up feedback to case management regarding status of readmissions and any non-admit decisions based on information provided by the LHC agency
• All other duties as assigned

Experience Requirements

• Must have one year of home health experience or one year of hospital case management experience

License Requirements

• Must have current RN or LPN or SW licensure in state of practice
• Reliable means of transportation and must have a current driver s license and auto insurance

Skill Requirements

• Must have excellent verbal and written communication skills with all members of the healthcare team
• Must have excellent organizational skills and ability to complete competing priorities
• Must have thorough understanding of home health qualifying criteria and coverage guidelines
• Proficient computer skills

LHC Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

At LHC Group we are proud to offer benefits that support your physical and emotional wellbeing. Review LHC Group s comprehensive benefits and perks: (Use the "Apply for this Job" box below)./LHCGBenefits

VNA of Maryland a part of LHC Group family of providers - the preferred post-acute care partner for hospitals, physicians, and families nationwide. We deliver high-quality, cost-effective care that supports our patients when and where they need it. From our home health, hospice, and community-based services to inpatient care at our clinics and hospitals, our mission is to reach more patients and families with effective and efficient healthcare.

More hospitals, physicians, and families choose LHC Group because we are united by a single shared purpose:
It s all about helping people.