Job Summary

WELLBE INTRODUCTIONThe WellBe care model is a Physician Led Advanced Geriatric Care Program focused on the quality of care of the frail, poly-chronic, and elderly Medicare Advantage patients. This population is typically underserved and very challenged with access to overall health care. To address these problems, we have elected to bring the care to the patient, instead of trying to bring the patient to the care. WellBe’s Care Model is to provide our members the entire continuum of care from chronic to urgent care in the home, hospital, skilled nursing facility, assisted living, palliative care, and to end of life care. WellBe's physician/advanced practicing clinician led geriatric care teams’ partner with the patient’s primary care physician to provide concierge level geriatric medical care and social support in the home as well as delivering and coordinating across the entire care continuum.

Job Description

GENERAL SUMMARY

The role of the Director of Transitional Care will be focused on developing and subsequently managing the overall transitional care strategy and team for our organization. This role will require the ability to coordinate with multiple teams across our organization including analytics, outreach, network development, operations, clinical and sales. The expectation for the role is to enhance our current transitional care model to meet the needs of our patients through improving our ability to engage our unengaged members while in a facility, and improve completion of our overall transition of care clinical visit upon patient discharge. In addition, this role will have direct reports of transitional care coordinators and transitional care liaisons and entails actively coaching, mentoring, training, motivating, and managing the performance of their designated team of Liaisons and Coordinators on a daily basis. Moreover, they are accountable for proficiently utilizing the daily operating systems and tools alongside their team, ensuring familiarity with and adherence to company policies and procedures, addressing inquiries and grievances from both team members and clients, and facilitating change management initiatives.

Job DescriptionWe are seeking a dynamic and experienced Director of Transitional Care to join our team. As a Director of Transitional Care, you will be responsible for developing the overall strategy and team to support transitional care activities including, tracking patients who have had a recent hospitalization/ED visit, connecting with patients while inpatient, scheduling transition of care visits, and completion of transition of care visits to meet HEDIS requirements. Additionally, this role will be responsible for overseeing the transitional team who serve as the primary point of contact between our healthcare organization and external stakeholders such as physicians, healthcare facilities, and community organizations.Key Responsibilities:

• Develop and implement strategies to enhance the effectiveness and efficiency of the transitional care program
• Work across the organizational teams to establish the overall strategy and team required to engage the unengaged patients who have been hospitalized or seen in an emergency department
• Support transitional care team in building and maintaining relationships with external stakeholders.
• Collaborate with internal departments, including marketing, sales, and clinical operations, to align transitional team activities with organizational goals and objectives
• Collaborate closely with Network development team to establish relationships in network facilities in order to allow transitional team to meet patients effectively when in facilities
• Supervise and mentor a team of liaisons and coordinators, providing guidance and support to ensure they meet performance goals and objectives and ownership of census outcome
• Provide training and ongoing education to transitional team on relevant topics such as communication skills.
• Monitor and evaluate the performance of transitional team, providing feedback and coaching as needed to address areas for improvement
• Establish benchmarks for transitional care teams and hold the team accountable to performance metrics
• Provide routine reporting to senior management, providing regular updates on performance, challenges, and opportunities
• Develop and maintain relationships with key external stakeholders, including physicians, hospital administrators, and community leaders, to support business development initiatives.
• Stay informed about industry trends, best practices, and regulatory changes related to healthcare marketing and business development
• Ensure appropriate coverage and responsible positions/teams to reach every patient who has been admitted to an inpatient facility or been seen in the emergency room
• Any other duties deemed necessary

Job Requirements

Educational Requirements:

• Bachelor's degree in healthcare administration, business administration, or a related field
• Preferred: Master’s of Health Administration or Master’s of Public Health

Required Skills and Abilities:

• 8 years of experience in healthcare, marketing, Case Management/Discharge Planning,
• 7 years of experience in a supervisory or managerial role.
• Competency in Google Workspace, MS Office software suite
• Preferred experience with HIPAA compliance rules
• Clinical experience preferred
• Excellent communication and presentation skills, with the ability to effectively engage with internal and external stakeholders.
• In-depth knowledge of Medicare Advantage Program.
• Demonstrated ability to develop and execute strategic plans to achieve organizational goals.

Travel requirements:

• Travel may be required up to 50% locally or nationally.

Work Conditions: 

• Standard office work conditions of sitting at desk and using electronic devices for long periods of time.
• Office temperatures may vary.

The preceding functions may not be comprehensive in scope regarding work performed by an employee assigned to this position classification. Management reserves the right to add, modify, change or rescind the work assignments of this position. Management also reserves the right to make reasonable accommodations so that a qualified employee(s) can perform the essential functions of this role.