Transitions of Care Medical Assistant - Member Outreach
Core
Advocate for members newly discharged from hospitals, coordinating care and resources to ensure safe home recovery and prevent readmissions.
Role type
Member outreach medical assistant
Builds
Post-discharge care coordination and support services
Domain
Healthcare / Managed care
Deliverable
client delivery
Required skills
Medical Assistant Certification, 2-3 years healthcare experience
Preferred skills
Bilingual (English/Spanish)
Responsibilities
Call patients post-discharge to check on recovery and needs; Coordinate with vendors for transportation, DME, meals, and home health; Schedule post-discharge appointments; Collaborate with patients, providers, and caregivers; Participate in interdisciplinary huddles and pilot programs; Access discharge records; Escalate clinical needs to the clinical team.