Aftercare Coordinator

DAY SHIFT

Work Hours:

8am- 4:30pm (Monday
- Friday)

Employment Type:

Full Time

Assesses complex patient aftercare needs, risks, support systems, service eligibility, and potential barriers to successful care transitions. Assists in the management of aftercare programs, projects, workflows, caseload priorities, service resources, and performance-improvement activities. Develops more complex individualized aftercare plans that address follow-up treatment, medications, appointments, community resources, equipment, education, and support needs. Implements processes to coordinate referrals, authorizations, appointments, provider communication, patient outreach, and confirmation of required services.

Ensures aftercare plans, referrals, interventions, patient communications, outcomes, and unresolved barriers are documented accurately and completed within established time frames. Confers with patients, families, clinical teams, care managers, payers, community providers, and external agencies to coordinate services and resolve transition-of-care concerns. Interprets clinical information, treatment recommendations, eligibility requirements, coverage limitations, and available resources to guide aftercare decisions and recommendations. Coaches patients, families, and less-experienced team members regarding aftercare expectations, available resources, care-transition practices, and methods for addressing service barriers.

Helps establish and implement aftercare procedures, educational materials, staff guidance, quality standards, and process improvements.

Plans and arranges own work; works with manager to prioritize projects.

Required:

Bachelor’s of Science in Nursing OR Bachelor’s degree in Physical Therapy from a school accredited by the American Physical Therapy Association OR Bachelor’s degree in Occupational Therapy from an accredited university OR Master’s degree in Speech
- Language Pathology from an accredited university OR Master’s Degree in Social Work Work Experience Education can be substituted for experience.

Required:

3 years Direct Patient Care Preferred: 1 years Burn unit experience

• Adept at problem solving and decision making skills|Medium|Required
• Adept at collaboration and teamwork|Low|Required
• Adept at growth mindset (agility and developing yourself and others) skills|Low|Required
• Adept at execution and delivery (planning, delivering, and supporting) skills|Low|Required
• Adept at digital literacy skills|Medium|Required

Required/ Preferred:
Must have current RN license or valid temporary permit with the Texas Board of Nursing or valid Compact RN license OR Must be licensed by the Texas State Board of Social Work OR Must have current licensure as a Physical Therapist with the Board of Physical Therapy Examiners for Texas OR Must be registered as an Occupational Therapist by the State of Texas OR Must be licensed by the Texas State Board of Examiners for Speech
- Language Pathology and Audiology and have completed all requirements for a Certificate of Clinical Competence (CCC) issued by the American Speech and Hearing Association (ASHA). ABLS within 12 months of hire; BLS within 6 months of hire;
Completes Phoenix Society SOAR Coordinator Course to facilitate the SOAR Program within 6 months of hire

Typically responsible for providing guidance, coaching and training to other employees within job area.

Communicates information within and outside the job area on matters that involve obtaining or providing difficult or sensitive information requiring some explanation and interpretation…