Agency: Inova Home Health Our culture and people are what set us apart from other post-acute care providers. We’re dedicated to the growth and development of our team to set them up for success. We CARE for our patients like they are our own FAMILY. Note: The Centers for Medicare & Medicaid Services (CMS), in collaboration with the Centers for Disease Control and Prevention (CDC), require COVID-19 vaccinations for all Medicare and Medicaid certified providers. Based on this regulation, all of our employees must be fully vaccinated or have a valid exemption. Schedule: Monday-Friday, 8AM-5PM $15,000 Sign on Bonus HOW YOU'LL MAKE A DIFFERENCE: At our agency, we care for patients where they spend the majority of their time – in their homes. This privileged position allows us to see things that are invisible to a patient’s primary care or hospital physician, and to deliver the best possible care tailored to each patient’s setting. As a Community Care Coordinator (CCC) the work you do every day makes a difference in the lives of our patients by providing patient healthcare coordination services, while nurturing relationships with referral sources. WHAT WE OFFER: We provide medical, dental, and vision insurance with flexibility for you to select what works best for you. Eligible teammates receive paid time off and may participate in the 401K, if they choose. Historically the company has matched 401K contributions which helps build your nest egg even faster. Finally, our benefit program includes company paid life, disability insurance, and a robust Employee Assistance Program. HOW YOU'LL WORK: You’ll transition patients to the homecare setting. You may attend discharge/multidisciplinary rounds in acute care, ambulatory and or other settings within the health system to share expertise and to assist the patient in transition of care from one setting to the next within the health system. MAJOR AREAS OF RESPONSIBILITY: Operations: Identify future patients and determine home care eligibility. Review patient insurance and medical documentation. Increase awareness of services offered. Discharge Planning: Assist hospital/facility personnel in the discharge planning process. Coordination of Care: Coordinate health care services as ordered by the attending physician and ensure coordination of all ancillary services following patient discharge. Customer Service: Function as a resource for your patients. Service account(s) to maintain facility relationships. Promote well-being of patients as a part of the facility team(s). Policies: Review and complete all clinical documentation following agency protocol and Medicare/Federal guidelines. Collaboration: Participate in care integration meetings. Build and maintain lasting positive relationships with patients/clients, facility/hospital personnel, physicians, and any other team members. Notify the referring facility manager before contacting patients. HARD & SOFT SKILLS: Effective and compassionate communicator with a positive attitude. Problem solver with the ability to handle situations that will provide the best possible outcome. Attention to detail is critical, as is being observant and following directions. REQUIREMENTS: Associates degree with a minimum of two years’ experience; or a combination thereof. Preferred Licensed in the state of services as a Licensed Practical Nurse (LPN), Physical Therapist, Physical Therapist Assistant, or Licensed Social Worker (LSW). Valid driver's license and auto insurance in your name as a driver. Capable of all physical demands. We are proud to be part of the Alternate Solutions Health Network family. Fairfax, VA We’ll help you put your passion for patient care to work. Apply today! This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee. Duties, responsibilities and activities may change or new ones may be assigned at any time with or without notice. We are an Equal Opportunity Employer. Inova Home Health is a partner with Alternate Solutions Health Network. Post-acute care is at the center of improving health outcomes. We care for patients where they spend the majority of their time – in their homes. This privileged position allows us to see things that are invisible to a patient’s primary care or hospital physician, and to deliver the best possible care tailored to each patient’s setting. As the healthcare industry continues to evolve away from hospital-centric care, our work, caring for patients in their homes becomes more important than ever. Our success helping patients recover comes from engaging with them. We start at the facility bedside and coordinate each patient's transition back to their home, ensuring a smooth transition and that their care plan is right for them. We support complex, high-acuity, medically-at-risk aging patients. This is the most challenging group of individuals to serve, and we find it the most rewarding. And we do this all in partnership with health systems. Together we create a seamless care environment that enables patients to receive excellent care in the setting that best meets their needs.