Transitional Case Manager

UnitedHealth Group•Granger, TX

4d•$24 - $43

About The Position

Explore opportunities with CHRISTUS VNA Hospice, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of Caring. Connecting. Growing together. As the Transitional Case Manager (TCM), you will be facilitating seamless transitions for patients from facility settings to post-acute care. You will verify home health orders, assess care requirements, and ensure continuity of care. Your role includes assessing patients' health literacy, involving patients and families in care planning, and providing education to improve outcomes and promote self-management. You will implement rehospitalization reduction initiatives for patients at risk and communicate with healthcare providers throughout the transition.

Requirements

Current, unrestricted RN, LPN, or SW licensure in state of practice.
Current CPR certification
Current driver's license, vehicle insurance, access to a dependable vehicle or public transportation.
1+ years of home health experience or 1 year of hospital case management experience.

Responsibilities

Educate patients on post-discharge follow-up, homebound criteria, and obtaining prescriptions
Assess readmission risk using the LACE tool
Ensure patients and families have agency contact information
Coordinate ancillary services (DME, Infusion) as needed
Assist in preparing for patient care post-discharge
Liaise between the agency and healthcare providers
Communicate patient transfers and coordinate resumption of care
Provide feedback on readmissions and non-admit decisions
Perform other duties as assigned