Fairhaven, Massachusetts21 days ago
Responsibilities: Under direction of the Transitional Care and Telehealth Manager or designee, perform diversified duties in support of the Post Acute Care Network (PACN) including but not limited to providing ongoing access to home health care for community residents , communicating with nursing facility regarding issues related to patient discharge process, scheduling in-service education programs for skilled nursing facility staff, providing consultation to the multi-disciplinary planning team, patients and/or their families and visiting clients in nursing facilities to contribute to plan of care. Work Cooperatively with all Southcoast Health staff including SPN, SPG, VNA and SHG, to oversee implementation of the PAC Program in community based facilities and to provide efficient transitions of care and improved quality outcomes.