Director Care Transitions
Company: KINDRED AT HOME
Posted on: July 14, 2019
Compassionate care, uncompromising service and clinical excellence
– that's what our patients have come to expect from our clinicians.
Kindred at Home, a division of Kindred Healthcare Inc., is the
nation's leading provider of comprehensive home health, hospice,
and non-medical home care services.
Kindred at Home, and its affiliates, delivers compassionate,
high-quality care to patients and clients in their homes or places
of residence, including non-medical personal assistance, skilled
nursing and rehabilitation and hospice and palliative care. Our
caregivers focus on each unique patient to deliver the appropriate
care and emotional support to our patients and their families.
The Director of Care Transitions is responsible for consulting with
agency clinical staff in one or more branches to help ensure
optimal continuity of care for patients transitioning between care
settings. Director of Care Transitions are responsible to assist in
care coordination and will not conduct patient assessments, patient
care planning or discharge planning. Director of Care Transitions,
may provide Home Health, Hospice, and Paliative Care education for
clinicians and foster collaboration among the interdisciplinary
care teams. Director of Care Transitions are expected to
communicate with the clinical team and help facilitate timely
patient follow-up. Director of Care Transitions are under the
general supervision of the Chief Clinical Operations Officer and
under established performance criteria.
- When home health agency staff determines that a patient may
benefit from hospice, or hospice agency staff determine that a
patient may benefit from home health care (or no longer meets the
eligibility criteria for hospice services), the Director of Care
Transitions may be called upon to assist in facilitating the
clinical consideration process and, as approprtiate, the patient's
transition between services.
- When Home Health or Hospice staff identifies a Palliative Care
need, Director of Care Transitions will assist in facilitating the
clinical conversations. Process and as appropriate, the patients
transition or addition of services.
- Work with home health and hospice staff to collect data, track
outcomes, and support strategic planning processes.
- Deliver quarterly reports to demonstrate outcomes and
performance improvement activities and may participate in the
establishment of program goals with leadership.
- Participates in special projects and performs other duties as
- Adheres to and participates in Company's mandatory training
which include but are not limited to HIPAA privacy
program/practices, Business Ethics and Compliance
programs/practices, and Company policies and procedures.
- Reviews and adheres to all Company policies and procedures.
- Promote a culture of collaboration and coordination between
Home Health and Hospice.
- Provide education regarding Home Health, Hospice, and
Palliative Care Services.
- Assist with clinical eligibility review for alternate services
which may include participation in case conferences or other
interdisciplinary team meetings.
- Use predictive analytic tools to improve quality of patient
care. This includes Data entry and management in the predictive
analytics program & Utilization of dashboards and reports for
- Nursing degree or equivalent with Bachelor of Science degree in
Nursing or Master of Science in Social Work preferred.
- Will consider other clinical or non-clinical personnel with
extensive hospice benefit and eligibility knowledge.
- Nurse Practitioner or Registered Nurse in applicable state
- Valid driver's license. Must have reliable transportation and
- A minimum of three years clinical home care and/or hospice
experience with at least one year in a clinical management role or
experience in acute care case management/discharge
planning/Clinical Director of Care Transitions role preferred.
- Excellent organizational skills and human relations skills.
- Excellent interpersonal communication and presentation skills
- Microsoft Office proficiency required.
- Reasonable accommodations may be made to enable individuals
with disabilities to perform the essential functions
- Excellent knowledge of state and federal home health/hospice
agency benefit, eligibility, regulations/Conditions of
Participation and Compliance standards and requirements.
- Must read, write and speak fluent English.
- Must have good and regular attendance.
Required Experience-MON-Job Location
Keywords: KINDRED AT HOME, Amarillo , Director Care Transitions, Executive , Amarillo, Texas
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