Transition Case Manager

Department

Disease Specific Programs
Job Summary

The Transition Case Manager (TCM) is responsible for leading the care transitions processes related to patients with health related social needs, identified high risk for readmission to post-acute level of care, ensuring effective coordination across the care continuum including the acute care setting, ambulatory and post-acute care settings, while assuming a strong role as liaison between Medical Staff, Case Managers, Nursing, Allied Health disciplines, hospital/clinic business/financial services, agencies across the continuum (internal and external) and payors, as well as, building sustainable care pathways that drive positive patient outcomes, reduces readmissions, decreases healthcare costs and optimizes the patient experience. In addition, the TCM assumes a leadership role in the identification and management of patients with catastrophic needs, health related social needs and expands collaboration with other service providers within the hospital and community exemplifying proactive, patient-oriented clinical practice that optimizes quality of care, utilization, effective cost, and patient experience.

Required Qualifications

- Require a master's degree from an accredited university in Social Work or related field (i.e., Social Sciences, Human Services, Psychology, Public Health).
- Require a minimum of one (1) year of practice in a hospital or preferred setting (i.e., home health, extended care facility, acute rehab, geriatric case management etc.). Intern field placement will be considered in lieu of work experience.

Preferred Qualifications

- Prefer previous experience with hospital information systems (order entry, results reporting), as well as proficiency with commonly used applications such as Microsoft Word and Excel.
- Prefer active Case Management certification (CCM-SW, ACM-SW), as well as membership in a relevant case management organization.
- Prefer bilingual.

Mandatory Education Preferred Education Required License and Certs Preferred License and Certs Employment Screening Requirements

As part of Sarasota Memorial Health Care Systems commitment to keeping people safe, all individuals providing care to vulnerable populations are required to undergo background screening through The Florida Care Provider Background Screening Clearinghouse.