Performs assessments and formulates discharge/transition plans in collaboration with patient, family and multidisciplinary healthcare team. Provides ongoing monitoring and evaluation of plans to meet the individual needs of patients throughout the care continuum. Works with the multidisciplinary healthcare team to ensure high quality patient care while maintaining fiscal integrity. Assists in resource management through facilitation of care and participation in program planning, data collection and analysis. Provides education to patients/families regarding coverage, care options and community resources. Utilization Care Coordinators master the principles of utilization management to assure the correct level of care throughout the system. High risk care coordinators are responsible for disease-specific population coordination and/or complex care coordination, providing transitional care for patients to appropriate providers, skilled nursing, home health, community support agencies and the patient's home.
Associate Degree RN preferred and a minimum of three to five years job-related experience
RN/MSW (For Social Workers, LMSW required and LCSW within six months of meeting eligibility requirements)
Desired but not required: BSN or equivalent education and experience. CCM and/or ACMA certification or equivalent.
Broad based clinical background and hospital experience. Excellent oral and written communication skills. Able to prioritize the daily workload and utilize tools dedicated to the position/function. Must be able to deal with a high degree of public and patient contact and interaction. Must be able to make independent decisions, perform concurrent tasks, manage stressful situations and balance multiple priorities.