Patient Transition Coordinator

Company: Ascension at Home together with Compassus Position Summary Weekend role covering every Saturday and Sunday, 8am - 6pm. MUST reside locally. Role is remote, but may require assistance at the hospital for additional coverage. The Patient Transition Coordinator supports seamless care transitions by coordinating referrals to hospice, home health, home infusion, and palliative services. This role works closely with Care Transition Coordinators and Home Health Care Transition Coordinators to ensure patients receive timely and appropriate services. The Coordinator promotes Compassus values of Compassion, Integrity, Excellence, Teamwork, and Innovation, upholds the Code of Ethical Conduct, and fosters positive working relationships across the organization and with external partners. Position Specific Responsibilities • Organizes, tracks, and builds a complete medical record for appropriate patient transition to the home health providers; and confirms start of care (SOC) for each patient referred. • Responsible for identifying all post-acute care needs and collaborating with the Care Transition Coordinator. • Collaborates with all Compassus/Ascension at Home intake teams. • Responsible for completing the transition of care, including submission of complete referral, and, securing outside agency placement if Compassus/Ascension at Home is unable to service the patient. • Organizes and prioritizes large volumes of information. • Displays exceptional customer service to our patients/families/referral sources. • Handles confidential and non-routine information. • Manages and creates general correspondences, memos, charts, tables, graphs, business plans, etc. • Utilizes computer software applications effectively in word processing, spreadsheets, database, and presentation software (MS Word, Excel, Access, PowerPoint). Work requires continual attention to detail in composing, typing, and proofing materials, establishing priorities, and meeting deadlines. • Performs other duties as assigned. Education and/or Experience Bachelor’s degree in a health-related field preferred. An equivalent combination of education and experience will be considered. Minimum of one (1) year of experience in a related health care setting preferred. One (1) year experience in home health, hospice and/or palliative preferred. Prior experience with electronic medical records preferred. Knowledge of home health, hospice, and palliative eligibility requirements preferred. Skills Mathematical Skills: Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers, common fractions, and decimals. Ability to compute rate, ratio, and percentage. Language Skills: Ability to read, analyze, and interpret general business periodicals, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, team members, investors, and external parties. Strong written and verbal communications. Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces hospice philosophy. Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 25 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization. At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. #LI-KM1 Build a Rewarding Career with Compassus At Compassus, we care for our team members as much as we care for our patients and their families. Through our Care for Who I Am culture, we show compassion, respect, and appreciation for every individual. Embark on a career that cares for you while you care for others. Your Career Journey Matters We’re dedicated to helping you grow and succeed. Whether you’re pursuing leadership roles, specialized training, or exploring new career paths, we provide the tools and support you need to thrive. The Compassus Advantage • Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter. • Career Development: Access leadership pathways, mentorship, and personalized professional development. • Innovation Meets Compassion: Collaborate with a supportive team using the latest tools and technologies to deliver exceptional care. • Enhanced Benefits: Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being. • Recognition and Support: Be celebrated for your contributions through recognition programs that honor your dedication. • A Culture of Belonging: Thrive in a culture where you can be your authentic self, valued for your unique contributions and supported in a community that embraces diversity and inclusion. Ready to Join? At Compassus, your career is more than a job—it’s an opportunity to make a lasting impact. Take the next step and join a team that empowers you to grow, innovate, and thrive.