TCM Care Coordinator


Working with our current transitional care program to avoid preventable readmissions of our patients to the hospital or ER.


  • Medical sales experience, such as for home health OR
  • Medical assistant training and experience
  • Sales skills
  • Personable, good critical thinking skills, exceptional communication skills
  • Ability to learn and navigate within different EMR systems utilized by various referral sources


  • Work in conjunction with referral sources such as hospitals, assisted living centers, etc to identify patients to be referred to PHC for TCM services
  • Verify that referred patients can be accepted by PHC (are within geographic service area, PHC is contracted with patient’s insurance, etc)
  • Meet with potential patients to explain services, assist with enrollment paperwork, relay completed forms to PHC intake personnel
  • Gather essential medical information and relay to PHC intake personnel
  • Conduct ongoing communication with referral sources as to status of referrals, particularly for those patients that PHC will be unable to accept
  • Prepare and distribute monthly reports tracking number of referrals per referral source, how many were accepted, whether patients receiving TCM services were readmitted or had an ER visit during the TCM 30 day window and any other information requested by the referral source or the PHC administrative team
  • Interfaces with PHC sales team when requested to assist with events or other tasks


To apply, please complete the following form and we will be in touch.