Transition of Care Coach (BH Licensed) - Thurston/Mason County

JOB DESCRIPTION **This is a hybrid role. Since your team is based in Thurston/Mason County, you will also need to be located there.** Job Summary Provides support for care transition activities. Facilitates transitional care processes and coordination for member discharge from hospital admission to all other settings. Strives to ensure that best possible services are available to members at time of hospital discharge and focuses on goal to reduce member readmissions. Contributes to overarching strategy to provide quality and cost-effective member care. Essential Job Duties • Follows member throughout a 30-day program that starts at hospital admission and continues oversight through transitions from acute setting to all other settings, including nursing facility placement/private home, with the goal of reduced readmissions. • Ensures safe and appropriate transitions by collaborating with the hospital discharge planner, as well as collaborating with hospitalists, outpati...