Care Coordinator, Care Management
5 months ago
Overview:
Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. Its also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change.
The Care Coordinator, Care Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment and discharge plan. Accountable for a designated patient caseload; assesses, plans, and facilitates with
patients, families and the multidisciplinary team to meet treatment goals, expected length of stay, and arrange for the appropriate next level of care. Oversees interfacility transitions and handoff between acute and post-acute services.
A day in the life of a Care Coordinator, Care Management at Hackensack Meridian Health includes:
- Assesses patients by screening for potential discharge needs regardless of race, age, sex, religion, diagnosis and ability to pay. Meets directly with patient/family to assess needs and develop an individualized care plan in collaboration with the physician and other members of the health care team.
- Facilitates communication and coordination between members of the health care team and involves the patient and family in the decision making process, in order to minimize fragmentation of services, manage resources and remove barriers to the plan of care.
- Maintains current information of community resources and refers patients to those community resources appropriate for the patient's care. Consults with other community agencies and committees to identify potential resources to support patients and their families.
- Works collaboratively with all team members of the multidisciplinary and post acute care teams to secure timely and appropriate transitions to the next level of care.
- Develops a discharge plan, in collaboration with the patient and support persons, identifying goals that will provide maximum benefit for each patient. Ensures that the discharge plan meets the continuing care needs of the patient.
- Documents and communicates information to the multidisciplinary team in order to coordinate and maximize care. Ensures that the medical record reflects the education provided, coordination of services, referrals made and authorizations obtained.
- Participates actively on appropriate committees, workgroups, and or meetings.
- Identifies and refers quality issues for review to the Quality Management Program.
- Participates in multidisciplinary rounds, specific to assigned units. Brings forth issues which impact on discharge as well as length of stay in a timely manner, for discussion and resolution.Performs appropriate reassessments and evaluates progress against care goals and the plan of care and revises plan, as needed. Ensures that the medical record reflects reassessment of the discharge plan at least weekly and upon any change in medical condition affecting the plan.
- Provides patients and families with resources and discharge options. Educates regarding the risks and benefits of discharge options and any available health care benefits.
- Provides appropriate CMS documents to the patient and family/support person as per regulatory guidelines (ie., Important Message 4 to 48 hours prior to discharge, appeal and HINN notices).
- Utilizes social determinants of health screening tools and resources during each intake assessment.
- Collaborates with all members of the multidisciplinary team to support the following functions; crisis intervention, counseling support and referrals, abuse and neglect reporting, adoption planning, guardianship, psychosocial assessments, observation management, capacity management, hospital throughput.
- Referrals should be made to the following as required/needed:
- Acute rehabilitation facilities
- Sub- Acute rehabilitation facilities
- Long Term Care facilities
- Assisted Living facilities
- Adult day program
- Level 1/Level 2 PASRR screening
- EARC screening
- Home Care
- Hospice
- Durable medical equipment
- Transport
- Dialysis
- Financial assistance
- Medication assistance
- Palliative Care
- Boarding home placement
- Mental health services
- Homelessness placement
- Substance abuse placement
- Division of Child Protection and Permanency
- Adult Protective Services
- Maintains annual competencies and ensures training and continuing education of the team in applicable platforms. (Epic, Xsolis Cortex, BI, Google Suites)
- Other duties and/or projects as assigned.
- Adheres to HMH Organizational competencies and standards of behavior.
Qualifications:
Education, Knowledge, Skills and Abilities Required:
- BSN or BSN in progress and/or willing to acquire within 3 years of hire or transfer into the position; or Masters Degree in Social Work.
- Effective decision-making skills, demonstration of creativity in problem-solving, and influential leadership skills.
- Excellent verbal, written and presentation skills.
- Moderate to expert computer skills.
- Familiar with hospital resources, community resources, and utilization management.
- Excellent written and verbal communication skills.
- Proficient computer skills that may include but are not limited to Microsoft Office and/or Google Suite platforms.
- Master's degree.
- NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed Clinical Social Worker.
- Care Management, CCMA or ACMA certification strongly preferred.
- Regular contact with medical personnel and its visitors.
If you feel the above description speaks directly to your strengths and capabilities, then please apply today
-
Patient Care Coordinator
2 months ago
Hackensack, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs...
-
Patient Care Coordinator
4 months ago
Hackensack, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs...
-
Patient Care Coordinator
4 weeks ago
Hackensack, United States Ennoble Care Full timeAbout Us Do not wait to apply after reading this description a high application volume is expected for this opportunity. Ennoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum...
-
Patient Care Coordinator
3 weeks ago
Hackensack, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs...
-
Patient Care Coordinator
4 weeks ago
Hackensack, New Jersey, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients across the country. Our clinicians go to the patient's home, providing a continuum of care for those with chronic conditions and limited mobility. We offer a variety of programs, including remote patient monitoring, behavioral health management, and...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, New Jersey, United States HACKENSACK UNIVERSITY MED CNTR Full timeAt HACKENSACK UNIVERSITY MED CNTR, we believe that our employees are the heart of what makes us better. Our team members are dedicated to helping our patients live better, healthier lives, and we help one another to succeed.With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, Minnesota, United States Hackensack Meridian Health Full timeAbout UsHackensack Meridian Health is a leading healthcare organization dedicated to delivering exceptional patient care and advancing the field of medicine. Our team members are the heart of what makes us better, and we're committed to supporting their growth and success.Job SummaryWe're seeking a skilled Care Coordinator, Care Management to join our...
-
Care Coordinator, Care Management Specialist
4 weeks ago
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeAbout the RoleWe are seeking a skilled Care Coordinator, Care Management to join our team at Hackensack Meridian Health. As a member of our healthcare team, you will be responsible for coordinating, communicating, and facilitating the clinical progression of patients' treatment and discharge plans.Key ResponsibilitiesAssess patients to identify potential...
-
Critical Care Nurse
4 weeks ago
Hackensack, New Jersey, United States Supplemental Health Care Full timeJob Title: ICU Registered NurseSupplemental Health Care is seeking a dedicated and compassionate ICU Registered Nurse to join our team for a travel nursing assignment in New Jersey.Job Summary:We are looking for a skilled and experienced ICU Registered Nurse to provide high-quality patient care in a fast-paced and dynamic environment. The ideal candidate...
-
Care Coordinator, Care Management
2 months ago
Hackensack, United States Hackensack Meridian Health Full timeA day in the life of a Care Coordinator, Care Management at Hackensack Meridian Health includes:Assesses patients by screening for potential discharge needs regardless of race, age, sex, religion, diagnosis and ability to pay. Meets directly with pat Care Coordinator, Management, Coordinator, Skills, Social Worker, Medical Equipment, Healthcare
-
Care Coordinator, Care Management
2 months ago
Hackensack, United States Hackensack Meridian Health Full timeOverview: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. Its also about how we support one...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, United States Hackensack Meridian Health Full timeOverview Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives - and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It's also about how we support one...
-
Care Coordinator, Utilization Management
2 months ago
Hackensack, United States Hackensack Meridian Health Full timeOverview: Our team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. Its also about how we support one...
-
Scheduling Coordinator
3 weeks ago
Hackensack, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care, palliative care, and hospice service provider with patients in New York, New Jersey, Maryland, DC, Virginia, and Georgia. Ennoble Care's clinicians go to the home of the patient, providing continuum of care for those with chronic conditions and limited mobility. Ennoble Care offers a variety of programs...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, United States Hackensack Meridian Health Full timeOur team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, United States Hackensack Meridian Health Full timeOur team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another...
-
Care Coordinator, Care Management
4 weeks ago
Hackensack, United States Hackensack Meridian Health Full timeOur team members are the heart of what makes us better. At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another...
-
Nurse Care Specialist
1 month ago
Hackensack, New Jersey, United States BAYADA Home Health Care Full timeWe are seeking a skilled Registered Nurse to provide high-quality care to our clients in their homes throughout Burke County.As a Registered Nurse with BAYADA Home Health Care, you will have the opportunity to work in a dynamic and supportive environment, providing one-on-one care to clients in their homes.Our Registered Nurses enjoy flexible schedules, a...
-
Scheduling Coordinator
4 weeks ago
Hackensack, Minnesota, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile primary care service provider with patients in various states.We seek individuals who are driven to make a difference and embody our motto, "To Care is an Honor."Job DescriptionEnnoble Care is seeking an experienced scheduling coordinator to join our team.Duties and Responsibilities:Scheduling patient appointments in...
-
Hackensack, New Jersey, United States Hackensack Meridian Health Full timeJob SummaryWe are seeking a highly skilled Clinical Care Coordinator, Utilization Management Specialist to join our team at Hackensack Meridian Health. This role is responsible for coordinating, communicating, and facilitating the clinical progression of patient treatment, ensuring that care meets evidence-based practice standards and regulatory...
