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Banner Health Transitional Care Associate in Gilbert, Arizona

Primary City/State:

Gilbert, Arizona

Department Name:

Case Mgmt-Hosp

Work Shift:

Day

Job Category:

Clinical Care

A rewarding career that fits your life. Those who have joined the Banner mission come from all walks of life, united by the common goal: Make health care easier, so life can be better. If changing health care for the better sounds like something you want to be part of, apply today.

As a Transitional Care Associate, you will facilitate the safe and timely transition from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care program. You will also facilitate discharge plan for the transition of care and services into the designated setting or service. Additional responsibilities include providing on-site or telephonic discharge arrangements to post-acute and community services. You should be willing to work collaboratively with care coordination team members to identify any barriers to a safe discharge, and works with patient/family to provide clear communication regarding discharge plan.

Schedule: 4 Ten hour shifts 7am-5:30pm, with rotating weekend. This position offers a weekend schedule which is eligible for a flat rate $3/hour weekend shift differential.

Your pay and benefits are important components of your journey at Banner Health. Banner Health offers a variety of benefits to help you and your family. We provide health and financial security options so you can focus on being the best at what you do and enjoying your life

Experience innovative technology and exceptional opportunities for growth and development at Banner Health's state-of-the-art hospital Banner Gateway Medical Center. With comprehensive electronic medical records, physician order entry, digital radiography and proprietary advanced patient monitoring, Banner Gateway provides you with the innovative resources you need to provide your patients with the best care possible. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. Located near Phoenix in Gilbert, Ariz., Banner Gateway Medical Center offers 176 private rooms, eight operating suites, a 37-bed emergency department and shares a campus with the Banner MD Anderson Cancer Center. Key specialties include oncology, obstetrics, bariatric surgery, emergency and other services that focus on meeting the changing needs of the dynamic and growing community we serve. About Banner MD Anderson Cancer Center Located in Gilbert, Ariz. (the Phoenix Metro area) on the Banner Gateway Campus, the center provides world-class care for oncology patients - both inpatient and outpatient - and has also brought leading oncology programs to the Banner Gateway campus including Stem Cell Transplantation and comprehensive Head & Neck cancer care. Our capabilities include five linear accelerator vaults, a brachytherapy vault, an advanced diagnostic imaging suite with PET/CT scan, more than 50 infusion bays, a cryopreservation lab and much more. Our inpatient medical oncology unit also incorporates a program that utilizes the electronic surveillance partnership in caring for the patient, where remote nurses have the ability to interact with patients via two way audio-video to assist the bedside nurse with patient care.

POSITION SUMMARY

This position facilitates the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care or community program. Facilitates discharge plan for the transition of care and services into the designated setting or service. Provides on-site or telephonic discharge arrangements to post-acute and community services.

CORE FUNCTIONS

  1. Processes and facilitates the timely discharge/transfer of clients from hospital care to identified post-acute setting. Notifies care coordination team member(s) if patient or caregiver demonstrate or verbalize any inability/concern to be able to manage their post-acute plan or responsibilities.

  2. Facilitates/ implements the care plan with proposed interventions in collaboration with healthcare team. Collaborates with all members of the healthcare team to implement, manage and communicate the transition of care arrangements.

  3. Participates in performance improvement projects, Banner initiatives and performs data collection for measurement of projects as assigned.

  4. Documents all interventions in the patient medical record both timely and accurately including all elements of the discharge plan. Performs transfer of accurate, pertinent patient information between all appropriate entities of the post-acute care continuum.

  5. Assist and support patients and families in making appropriate arrangements for the post-acute plan. Performs follow-up calls to patients and providers as indicated and report any concerns to leadership.

  6. Serves as an intermediary when providing community resources to patients, caregiver, and families. Discusses with patient, caregiver, and/or family maintaining clear communication regarding anticipated discharge date and potential care settings.

  7. Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with transition of care planning and choices.

  8. Employee has freedom to determine how to best accomplish functions within established procedures and implements the discharge plan under the delegated authority of a provider, licensed MSW, registered nurse or other licensed healthcare professional. Confers with supervisor/manager on any unusual situations and communicates plans and activities for patient discharge across the care continuum. Internal customers: Post-acute services team members and all levels of nursing management and staff, medical staff, and all other members of assigned facility interdisciplinary health care team. External customers: home health agencies, nursing homes, insurance providers, group homes, assisted living facilities, hospice, long-term acute care hospitals, inpatient rehabilitation facilities, volunteer agencies, county/governmental agencies and medical supply companies and others as required.

MINIMUM QUALIFICATIONS

A Bachelor’s degree in social work or related degree or a Licensed Practice Nurse, or a Licensed Respiratory Therapist required.

Must have knowledge of government/community agencies and resources, such as Medicare/Medicaid, long term care or other applicable resources/services. Must demonstrate effective communication and customer service skills, human relation skills and time management skills. Must be able to work flexible hours and work weekends on rotation. BLS required. (BLS is not required for employees working in the Insurance Division.) Employees working at the Boswell Skilled Nursing Facility must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment.

PREFERRED QUALIFICATIONS

Previous experience in health care service setting, interacting with patients and families, usually obtained through work in social services, as a licensed practical nurse or in a discharge planning setting.

Additional related education and/or experience preferred.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability.

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