at Beebe Healthcare in Lewes, Delaware, United States
Job Description
Become part of the Beebe team - an inclusive team positioned in a vibrant, coastal community. Enjoy a fulfilling career as you support the health of our patients and a team focused on excellence.
Overview
The Care Transition Scheduler serves as a critical member of the care coordination team responsible for connecting patients discharged from inpatient and emergency department settings to timely follow-up care and community resources. The position focuses on reducing barriers to care, preventing avoidable emergency department visits and readmissions, improving access to primary and specialty care, and supporting successful care transitions.
Responsibilities
Essential Duties and Responsibilities
- Meet with patients prior to discharge from inpatient units and the Emergency Department.
- Schedule primary care follow-up appointments prior to discharge.
- Schedule specialty care appointments as ordered or recommended.
- Ensure appointment details are documented and included in discharge instructions.
- Identify social determinants of health barriers including transportation, housing, food insecurity, financial concerns, and caregiver support needs.
- Facilitate referrals to Community Health Workers, Social Workers, Care Coordinators, and community agencies.
- Coordinate transportation resources when available.
- Collaborate with physicians, nurses, case managers, social workers, and patient access staff.
- Document all patient interactions and referral activities in the electronic health record.
- Participate in quality improvement initiatives focused on reducing readmissions and ED utilization.
