Easter Seals Jobs

Description To Heal. To Teach. To Discover. At University Hospitals, this is more than just our mission. These words embody the opportunities available to the many world-class doctors, nurses, health care professionals, and support staff that choose to join UH and Be the Difference. A Brief Overview Under the daily supervision of the Transitional Care Lead and reporting to the Nursing Supervisor for Care Management, Primary Care Institute (PCI), this position serves as a member of the PCI healthcare team to support patients/caregivers in the process of navigating safe transitions from one site of care to another, such as hospital to home, hospital to post-acute care, post-acute care to home. What You Will Do Perform transition of care follow-up to patients discharged from a hospital, SNF, or acute care rehab Coordinates continuity of care with patients and families following hospital admission discharge Performs transition of care phone call to patient to review and educate patient on provider follow-up, diagnostic or procedure follow-up Performs medication review with support and under the direction of the transitional care RN Provides patients/family/caregiver with information on diagnosis and self-care management Refers to interdisciplinary team members if patient meets the criteria Establish discharge referrals and assist in scheduling any required follow-up with providers, community supports and services Escalates patient concerns to transitional care RN as needed Demonstrates a thorough understanding of, and ability to connect patients with, available resources in the Northeast Ohio community focused on improving the health, wellness, and overall quality of life for a patient. Communicate with Home Health Care agencies or community agencies utilized by the patient. Provides ongoing support as needed or refer to RN based on patient's condition and level of acuity Document within the medical record per established guidelines Assists manager with developing and facilitating process improvement initiatives. Facilitates unit operations by managing patient flow. Works as a healthcare advocate for their patients and communicates with other healthcare providers to accurately update documents and schedule appointments. Assist patients in removing transportation and other barriers that could prevent patients from getting healthcare Additional Responsibilities Performs other duties as assigned. Complies with all policies and standards. For specific duties and responsibilities, refer to documentation provided by the department during orientation. Must abide by all requirements to safely and securely maintain Protected Health Information (PHI) for our patients. Annual training, the UH Code of Conduct and UH policies and procedures are in place to address appropriate use of PHI in the workplace. Equal Opportunity Employer -- minorities/females/veterans/individuals with disabilities/sexual orientation/gender identity