Specializing in catastrophic injuries, responsible for skilled care coordination of Beaumont Health System's Auto Injury patients transitioning them from hospital to home. Collaboration sensitive to Orthopedic Surgeons, DME specific needs, Wound Care, IV infusion, PT/OT directives, and care plan specifics for individualized needs. Specific call points within hospital setting are ICU, Orthopedics, PM&R, Childrens, IPR, Finance, and Care Managers. Coordinate transition care plans for patients in LTC and SAR facilities working with DON, Therapists, Billing, and Medical Directors.