Job Summary and ResponsibilitiesAs our RN Care Coordinator, you will be a central figure in patient care, seamlessly navigating the healthcare journey to achieve optimal outcomes and an exceptional patient experience.
Every day, you will strategically assess, plan, and facilitate comprehensive care across the continuum, expertly advocating for patients while collaborating with physicians, nursing, departments, insurers, and post-acute providers to ensure timely, high-quality transitions.
To be successful in this role, you will possess strong clinical acumen, exceptional communication and advocacy skills, and a strategic mindset, all driven by a passion for optimizing patient care across every touchpoint.
Responsibilities: - Completes and documents a discharge planning assessment on those patients identified by the designated screening process, or upon request, and reassesses the patient as appropriate while updating the plan accordingly.
- Facilitates the development of a multidisciplinary discharge plan, engaging other relevant health team members, the patient and/or patient representative, and post-acute care providers in accordance with the patient's clinical or psychosocial needs, choices, and available resources.
- Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon patients' clinical needs.
- Identifies risk for readmission and implements interventions to mitigate those risks for at least a 30-day period.
- Responsible for patient education and advocacy.
Job RequirementsRequired - Graduate of an accredited school of nursing
- Minimum of two (2) years of acute hospital clinical experience OR a Master's degree in Case Management or Nursing field in lieu of one year of experience
- Current RN license in the state(s) covered (California - RN: CA)
- AHA-BLS certification
Required Knowledge, Skills, and Abilities- Ability to apply clinical guidelines to ensure progression of care
- Critical thinking and problem-solving skills
- Effective collaboration with multiple stakeholders
- Strong professional communication skills
- Understanding of utilization management and case management program integration
- Ability to work effectively as a team player and assist team members as needed
- Thrive in a fast-paced, self-directed environment
- Knowledge of CMS standards and requirements
- Ability to prioritize work and delegate appropriately
- Highly organized with excellent time management skills
Preferred Education, Experience, and Licensure and Certifications
- Bachelor's Degree in Nursing (BSN) or related healthcare field
- At least five (5) years of nursing experience
- Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or Utilization Management (UM) Certification
