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Primary City/State:

Phoenix, Arizona

Department Name:

Case Mgmt-Hosp

Work Shift:

Day

Job Category:

Clinical Care

Great careers start with great training. The people of Banner Health are focused on delivering excellent care to our patients. In return, we are committed to excellence in personal development for all our team members. Apply today.

As the Transitional Care Associate, you will assist Case Managers on the Care Coordination Team with the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care or community programs. You will facilitate the plan for the transition of care and services into the designated setting or service. You will work at Banner University Medical Center Phoenix.

This is a full-time position working eight-hour day shifts. Expected hours are 8AM to 4:30PM. Weekend rotations will be required for this role. If this role sounds like the one for you, apply today!

University Medical Center Phoenix is a nationally recognized academic medical center. The world-class hospital is focused on coordinated clinical care, expanded research activities and nurturing future generations of highly trained medical professionals. Our commitment to nursing excellence has enabled us to achieve Magnet™ recognition by the American Nurses Credentialing Center. The Phoenix campus, long known for excellent patient care, has over 730 licensed beds, several unique specialty units and is the new home for medical discoveries, thanks to our collaboration with the University of Arizona College of Medicine - Phoenix. Additionally, the campus responsibilities include fully integrated multi-specialty and sub-specialty clinics.

POSITION SUMMARY

This position facilitates the safe and timely transition of clients from acute care to alternative levels of care such as skilled nursing facility, long-term acute care, inpatient rehabilitation, home infusion therapy, hospice and/or home care or community program. Facilitates discharge plan for the transition of care and services into the designated setting or service. Provides on-site or telephonic discharge arrangements to post-acute and community services.

CORE FUNCTIONS

1. Processes and facilitates the timely discharge/transfer of clients from hospital care to identified post-acute setting. Notifies care coordination team member(s) if patient or caregiver demonstrate or verbalize any inability/concern to be able to manage their post-acute plan or responsibilities.

2. Facilitates/ implements the care plan with proposed interventions in collaboration with healthcare team. Collaborates with all members of the healthcare team to implement, manage and communicate the transition of care arrangements.

3. Participates in performance improvement projects, Banner initiatives and performs data collection for measurement of projects as assigned.

4. Documents all interventions in the patient medical record both timely and accurately including all elements of the discharge plan. Performs transfer of accurate, pertinent patient information between all appropriate entities of the post-acute care continuum.

5. Assist and support patients and families in making appropriate arrangements for the post-acute plan. Performs follow-up calls to patients and providers as indicated and report any concerns to leadership.

6. Serves as an intermediary when providing community resources to patients, caregiver, and families. Discusses with patient, caregiver, and/or family maintaining clear communication regarding anticipated discharge date and potential care settings.

7. Maintains knowledge of Medicare, Medicaid and other program benefits to assist patients with transition of care planning and choices.

8. Employee has freedom to determine how to best accomplish functions within established procedures and implements the discharge plan under the delegated authority of a provider, licensed MSW, registered nurse or other licensed healthcare professional. Confers with supervisor/manager on any unusual situations and communicates plans and activities for patient discharge across the care continuum. Internal customers: Post-acute services team members and all levels of nursing management and staff, medical staff, and all other members of assigned facility interdisciplinary health care team. External customers: home health agencies, nursing homes, insurance providers, group homes, assisted living facilities, hospice, long-term acute care hospitals, inpatient rehabilitation facilities, volunteer agencies, county/governmental agencies and medical supply companies and others as required.

Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Banner Health with an excellent service experience by consistently demonstrating our core and leader behaviors each and every day.

NOTE: The core functions are intended to describe the general content of and requirements of this position and are not intended to be an exhaustive statement of duties. Specific tasks or responsibilities will be documented as outlined by the incumbent's immediate manager.

SUPERVISORY RESPONSIBILITIES

DIRECTLY REPORTING

None

MATRIX OR INDIRECT REPORTING

None

TYPE OF SUPERVISORY RESPONSIBILITIES

N/A

Banner Health Leadership will strive to uphold the mission, values, and purpose of the organization. They will serve as role models for staff and act in a people-centered, service excellence-focused, and results-oriented manner.

PHYSICAL DEMANDS/ENVIRONMENT FACTORS

DP - Typical Direct Patient Care environment: (Nutrition Rep, Chaplain, RN)

Able to stand, walk, bend, squat, reach, and stretch frequently.

Possess physical agility and adequate reaction time to respond quickly and appropriately to unexpected patient care needs.

Needs adequate hearing and visual acuity, including adequate color vision.

Requires fine motor skills, adequate eye-hand coordination, and ability to grasp and handle objects.

Able to use proper body mechanics to assist patients in ambulating, transferring in and out of bed, chair or wheelchair.

May be required to lift up to 75 pounds.

Must use standard precautions due to threat of exposure to blood and bodily fluids.

Needs ability to communicate effectively through reading, writing, and speaking in person or on telephone.

May require periodic use of personal computer.

MINIMUM QUALIFICATIONS

A Bachelor’s degree in social work or related degree or a Licensed Practice Nurse, or a Licensed Respiratory Therapist required.

Must have knowledge of government/community agencies and resources, such as Medicare/Medicaid, long term care or other applicable resources/services. Must demonstrate effective communication and customer service skills, human relation skills and time management skills. Must be able to work flexible hours and work weekends on rotation. BLS required. (BLS is not required for employees working in the Insurance Division.)

Employees working at Banner Behavioral Health Hospital, BTMC Behavioral, and BUMG, BUMCT, or BUMCS in a Behavioral Health clinical setting that serves children must possess an Arizona Fingerprint Clearance Card at the time of hire and maintain the card for the duration of their employment. An Arizona Criminal History Affidavit must be signed upon hire.

PREFERRED QUALIFICATIONS

Previous experience in health care service setting, interacting with patients and families, usually obtained through work in social services, as a licensed practical nurse or in a discharge planning setting.

Additional related education and/or experience preferred.

DATE APPROVED 03/30/2025

EEO Statement:

EEO/Disabled/Veterans (https://www.bannerhealth.com/careers/eeo)

Our organization supports a drug-free work environment.

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Privacy Policy (https://www.bannerhealth.com/about/legal-notices/privacy)

EOE/Female/Minority/Disability/Veterans

Banner Health supports a drug-free work environment.

Banner Health complies with applicable federal and state laws and does not discriminate based on race, color, national origin, religion, sex, sexual orientation, gender identity or expression, age, or disability