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

  • Great benefits

  • Immediate Health Insurance Coverage

  • Career growth and advancement potential

Work Hours/Shift:

  • 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

Job Summary:

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.