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Support Coordinator RN

5 months ago

Detroit, United States Detroit Area Agency on Aging Full time
Description

Conducts face-face assessments/reassessments from a clinical perspective on designated assigned cases.

•Obtain medical history and document pertinent clinical information from participants related to their medical diagnoses and assessment findings

•Utilizing assessment, develops a plan of care directed by the client (Person Centered Care Planning)

•Monitor participants for conditional changes associated with their physical and mental health well-being

•Preforms monthly medication reconciliations

•Develops and completes care plans and other required documents. Reviews and modifies care plans as directed by the client / caregiver during the reassessment and obtains the clients signature of approval.

•Maintains regular, ongoing contact with clients, caregivers, physicians and service providers listed on service plan through home visits and phone calls.

•Educates clients, caregiver and service providers regarding the roles and responsibilities of each party, assuring that services are provided as documented in the care plan.

•Conducts Nursing Facility Level of Care assessment as required.

•Continues to evaluate the appropriateness of the service plan, adjusting it as needed.

•Monitors client progress in relation to goals and objectives listed in the care plan.

•Interfaces with community resources as needed to support client.

•Collaborates with peers (RN or SW) in coordinating services.

•Produces timely and accurate commuter entry reports.

•Maintains client confidentiality

•Participates in training, supervisory meetings, in-services and continuing education opportunities.

•Abides by DAAA's and Waiver Codes of Ethics.

•Participates in other duties as assigned.

•

Requirements

Education:

•Possess a Registered Nurse License in the State of Michigan

Experience:

•Two-three years of experience completing intakes, pre-screening, and/or assessments, preferably in a health care or human service setting serving the elderly and/or disabled population.

•Knowledge of Medicaid and Medicare regulations.

•Ability to complete assessments using computerized screening tools.

•Excellent Customer Service skills and ability to de-escalate callers.

Computer literate: Word, Excel, Outlook

•Excellent communication skills, written and verbal

•Current Michigan driver's license and access to a car.

•Ability to analyze and problem solve.