RN; Transition of Care Coach NM

About This Role

The Transition of Care Coach provides support for care transition activities, facilitating coordination for member discharge from hospital to other settings. This role is ideal for individuals who are proactive and detail-oriented, focusing on reducing member readmissions.

• Pay
  : $26.41 - $51.49/hour
• Location:
  
  Remote, NM
• Schedule:
  
  Full Time

• Follow members throughout a 30-day program from hospital admission to transitions to other settings.
• Collaborate with hospital discharge planners, hospitalists, outpatient providers, and family/support networks.
• Ensure transitions to settings with adequate caregiving and functional support.
• Work with ancillary providers and public agencies to ensure necessary services are in place.
• Conduct face-to-face visits with members in the hospital and home visits for high-risk members post-discharge.
• Coordinate care and reassess member needs using the Coleman Care Transition model post-discharge.
• Educate and support members on medication management, follow-up care, and other key areas.
• Use motivational interviewing to educate and motivate change during member contacts.
• Assess barriers to care and provide coordination and assistance to address concerns.
• Facilitate interdisciplinary care team meetings and collaboration.

• Education:
  • Registered Nurse (RN) License must be active and unrestricted in state of practice.
• Experience:
  • At least 2 years experience in health care, with at least 1 year in hospital discharge planning, care management, or behavioral health.
• Licenses &
  
  Certifications:
  • Valid and unrestricted driver's license.
  • Knowledge of or experience using the Care Transitions Intervention (CTI) or similar model.

• Competitive benefits and compensation package.

Molina Healthcare is a leading healthcare provider committed to delivering exceptional patient care. They focus on providing quality and cost-effective services to their members.