AdventHealth Health Transition Advisor in MAITLAND, Florida
Health Transition Advisor AdventHealth Corporate
Location Address: 101 Southhall Lane Maitland, FL 32751
Top Reasons To Work At AdventHealth Corporate
Immediate Health Insurance Coverage
Career growth and advancement potential
- Full-Time, Monday – Friday
You Will Be Responsible For:
Develops and maintains collaborative relationships with hospital staff, physicians, and post-acute providers, and facilitates an evidence-based, multi-disciplinary approach to support patients via navigation of the healthcare continuum
Meets with patients/families and patient care team to develops plans of care, aligns patients’ needs and goals with post-acute care treatment planning. Communicates goals with physician and post-acute care providers. Incorporates a model promoting quality care and cost-effective outcomes.
Monitors clinical progress for the designated timeframe (or 90 days) after transition to the post-acute environment. Communicates delays in care, functional status and/or changes in clinical status to the surgeon or primary care provider (PCP) and coordinates required follow-up and monitoring.
Works with involved physicians on implementing protocols for patients who are discharged to an IRF, SNF, Home Health agency, or outpatient therapy; and ensures availability of physicians to follow the plan of care. Develops a communication system and routine meetings with SNF and IRF to ensure that patient is adhering to designed protocol and progressing as expected. Discusses and approves any outliers from established protocol.
Leads and coordinates activities of multi-disciplinary rounds, to include but not limited to facilities, Medical Directors and PHSO Health Management team necessary to ensure seamless and effective transitions and positive health outcomes
Acts as a resource to ensure communication between acute hospital and post-acute entity to prevent unnecessary re-admissions back to the acute setting, or, if necessary ensure a smooth re-admit
Coordinates patient’s transitions of care. Communicates with patient to ensure patient choice as they move from one level of care to another. Identifies patient choice and secures the necessary resources to administer services
What You Will Need:
Graduate from an accredited school of nursing
Four years of hospital or post-acute care coordination experience
Comprehensive understanding of Value Based Care principles
The Post-Acute Health Advisor is responsible for the transition and coordination of care for patients as they transition through the continuum of care. Services are provided in a collaborative process that assesses, plans, implements, coordinates, monitors and evaluates options and services required to meet the patient’s post-acute health needs, using communication and available resources to promote quality, cost-effective outcomes.
Nurse, Case Manager, Case Management, Care
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.
We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.