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Care Transition Manager

Care Transition Manager

Job Title: Care Transition Manager
Job Category: Nursing (RN)
Division: Torrance Health IPA
Position Type: Full time
Shift Length: TBD
Location: Torrance, CA

Resumes go to: Barbara.Latam@tmmc.com

The Care Transition Manager is responsible for managing the coordination of care for a specific patient population. The daily tasks will focus on patient advocacy, assessment, discharge planning, collaborative interdisciplinary communication (hospital, health plan, medical group, patient, and other ancillary departments), education, and resource management. The Care Transition Manager will take the lead role in decision making regarding the coordination of care based on the patient needs and in collaboration with the health care team at Torrance Memorial Medical Center and TMIP/THIPA.

The Care Transition Manager will engage the patient and caregivers upon admission to the hospital and throughout the hospital stay to reinforce the education of the patient by the Unit Nurse about self-management, medication use, advance care planning, discharge instructions, transition preparedness, follow-up appointments and care, and urgent resources. The Care Transition Manager utilizes teach-back methodology to assure the patient understands the treatment plan and is well prepared for transition to the next level of care. The Care Transition Manager links patients and families with appropriate providers and community resources after their hospital stay, while ensuring that care provide is safe, effective, client centered, timely, efficient, and equitable.

The role focuses on coordination of care throughout the continuum while creating positive partnerships with hospital staff, health plan leadership, physicians, community agencies and other key disciplines in order to pace the care toward optimal outcomes within the appropriate level of care and setting.

Requirements:

  • Graduate of a state approved RN program; BSN required with unrestricted CA license
  • Minimum of three years of RN experience required and one to two years case management experience required
  • Skilled in MSWord, Excel, Electronic Health Records, Intergual, CERME or Milliman
  • CCM or ACM certification is preferred
  • Excellent verbal and written skills required. Must read, speak and write English fluently

Qualified candidates should submit their resume to Barbara.Latam@tmmc.com for consideration.