Senior Care Coordination Nurse
2 days ago
Job Overview
The Senior Care Coordination Nurse (RN Sr) plays a pivotal role in evaluating transitional care requirements, orchestrating care throughout the healthcare continuum, and collaborating with patients and their families to ensure comprehensive care needs are fulfilled, particularly for the most intricate cases during acute hospital admissions. This position demands substantial clinical acumen to partner with physicians and healthcare teams to facilitate optimal and efficient treatment strategies, thereby enhancing the progression of care during hospitalization and planning for post-discharge support.
Key Responsibilities Include
- Assessing transitional care needs, clinical care progression, psychosocial evaluations, participating in patient/family care discussions, interdisciplinary rounds, and providing education to patients and families.
- Effectively collaborating with utilization review nurses, physicians, and interdisciplinary teams to deliver a thorough assessment of patients' medical and psychosocial needs, along with any social determinants of health that may impact care.
- Ensuring patients are on track towards their discharge goals and addressing any barriers that may arise.
- Seeking consultations from relevant disciplines/departments to proactively identify and resolve delays, thereby expediting care and facilitating timely discharge.
- Participating in the orientation and mentorship of new staff members as needed, guiding them in clinical progression and case reviews.
- Other duties may be assigned as necessary.
Assessment: Initiates assessments based on preliminary screenings to evaluate patients' psychosocial risk factors and resource availability for discharge. Collaborates with financial counselors and utilization management nurses to assess insurance and coverage requirements for all payers, ensuring compliance. Works closely with patients, families, physicians, and care teams to establish and support care progression and discharge plans. Engages in regular meetings with physicians and care teams to ensure timely and effective patient management. 30%
Care Progression: Collaborates with physicians and care teams to enhance communication regarding patient care progression, ensuring timely and efficient service delivery. Proactively identifies and addresses delays or obstacles in diagnostics or treatments that could hinder discharge. Discusses medical necessity for inpatient testing that may be more suitable in an outpatient context with physicians. Actively works to eliminate discharge barriers and escalates issues to appropriate leaders for swift resolution. 20%
Disposition Planning: Oversees all aspects of discharge planning for assigned patients, implementing plans promptly and providing resources efficiently. Engages with patients and families to assess needs and develop tailored discharge plans in collaboration with physicians. Identifies and documents barriers to timely disposition and responds to referrals for post-acute needs from physicians and care teams. Participates in interdisciplinary rounds to confirm estimated discharge dates and recommend optimal care transitions. Ensures consensus on discharge plans among patients, families, physicians, care teams, and payers. Initiates post-acute referrals through departmental processes for timely transitions to the next level of care, considering cultural and religious beliefs in service provision. 20%
Documentation: Completes initial clinical and psychosocial assessments, ensuring documentation is accurate and up-to-date in medical records. Maintains clear and concise records of interactions with patients, families, physicians, and community partners related to discharge plans. Tracks avoidable days and reports trends leading to undesirable outcomes. 10%
Precepting/Mentoring: Assists leadership in mentoring new hires as needed, guiding less experienced staff in navigating challenging situations while supporting patients and families through the continuum of care. Serves as a preceptor and mentor for student interns. 10%
Professional Development and Initiative: Completes all required competency assessments, mandatory education, and population-specific training. Supports departmental goals that contribute to the overall success of the organization. 10%
Required Minimum Education
Bachelor's Degree in Nursing from an accredited institution is required.
Required Minimum License(s) and Certification(s)
All certifications must be obtained upon hire unless otherwise specified.
- Registered Nurse (Single State) or RN - Multi-state Compact
- Basic Life Support (BLS) - Instructor
- Accredited Case Manager or Certified Case Manager
Required Minimum Experience:
Minimum of 3 years of experience as a staff nurse in an acute care hospital setting is required.
Minimum of 2 years of experience as a case manager in a hospital or payer-based model, demonstrating expertise in case management competencies to guide the care team through complex discussions is required.
Required Minimum Skills
Exceptional written and verbal communication skills.
Must exhibit maturity, self-confidence, objectivity, and a positive demeanor.
Self-directed with the ability to perform well under pressure, adapt to change, and thrive in a fast-paced environment.
Strong assessment, interviewing, organizational, and problem-solving capabilities.
Knowledge of local, state, and federal regulations is required.
Familiarity with community and state-wide resources and programs.
Ability to collaborate effectively with physicians, care team members, and patients/families throughout the continuum of care.
-
Senior Care Coordination Nurse
2 weeks ago
Griffin, Georgia, United States Wellstar Health System Full timeFacility: Wellstar Health SystemPosition OverviewThe Senior Care Coordination Nurse (RN Sr) plays a crucial role in evaluating transitional care requirements, orchestrating care throughout the healthcare continuum, and collaborating with patients and their families to ensure comprehensive care needs are addressed, particularly in complex cases during acute...
-
Senior Care Coordination Nurse
2 weeks ago
Griffin, Georgia, United States Wellstar Health System Full timeFacility: Wellstar Health SystemJob OverviewThe Senior Care Coordination Nurse (RN Sr) plays a pivotal role in evaluating transitional care requirements, orchestrating care throughout the healthcare continuum, and collaborating with patients and their families to ensure that care needs are effectively addressed during complex acute admissions. This position...
-
Senior Care Coordination Nurse
2 weeks ago
Griffin, Georgia, United States Wellstar Health System Full timeFacility: Wellstar Health SystemPosition OverviewThe Senior Care Coordination Nurse is tasked with evaluating transitional care requirements, orchestrating care throughout the healthcare continuum, and collaborating with patients and their families to ensure comprehensive care for the most intricate cases during acute hospital stays. This role demands a high...
-
Senior Healthcare Provider at Ennoble Care
2 weeks ago
Griffin, Georgia, United States Ennoble Care Full timeAbout Ennoble CareEnnoble Care specializes in delivering mobile primary care, palliative care, and hospice services to patients across various regions. Our dedicated healthcare professionals provide essential medical services directly in the homes of individuals with chronic illnesses and mobility challenges. We are committed to offering a variety of...
-
Senior Advanced Provider at Ennoble Care
2 weeks ago
Griffin, Georgia, United States Ennoble Care Full timeJob OverviewAbout Our OrganizationEnnoble Care is a dedicated provider of mobile primary care, palliative care, and hospice services, serving patients across multiple states. Our clinicians deliver personalized care directly to patients' homes, ensuring a continuum of support for individuals facing chronic conditions and mobility challenges. We offer a range...
-
Licensed Practical Nurse
5 days ago
Griffin, Georgia, United States Professional Case Management Full timeAbout the RoleWe are seeking a skilled Licensed Practical Nurse (LPN) to join our team as a Home Care Specialist. As an LPN with Professional Case Management, you will have the opportunity to make a meaningful difference in the lives of our clients while enjoying the flexibility of working on your own schedule.Key ResponsibilitiesDeliver High-Quality Patient...
-
Griffin, Georgia, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile healthcare provider specializing in primary care, palliative care, and hospice services. Our team of clinicians delivers high-quality care to patients in their homes, focusing on those with chronic conditions and limited mobility. We offer a range of programs, including remote patient monitoring, behavioral health management,...
-
Critical Care Registered Nurse
3 days ago
Griffin, Georgia, United States Wellstar Health System Full timeJob SummaryThe Registered Nurse - Critical Care is a key member of our interdisciplinary team, responsible for delivering high-quality, patient-centered care to individuals in critical need. As a proactive and compassionate nurse, you will work closely with patients, families, and healthcare professionals to ensure seamless care coordination and optimal...
-
Critical Care Registered Nurse
2 weeks ago
Griffin, Georgia, United States Wellstar Health System Full timeJob SummaryThe Registered Nurse - Critical Care is a key member of our interdisciplinary team, responsible for delivering high-quality, patient-centered care to individuals in critical need. As a proactive and compassionate nurse, you will work closely with patients, families, and healthcare professionals to ensure seamless care coordination and optimal...
-
Critical Care Registered Nurse
2 weeks ago
Griffin, Georgia, United States Wellstar Health System Full timeJob SummaryThe Registered Nurse - Critical Care is a key member of our interdisciplinary team, responsible for delivering high-quality, patient-centered care to individuals in critical need. As a proactive and compassionate nurse, you will work closely with patients, families, and healthcare professionals to ensure seamless care coordination and optimal...
-
Critical Care Registered Nurse
7 days ago
Griffin, Georgia, United States Wellstar Health System Full timeJob SummaryThe Registered Nurse - Critical Care Specialist is a key member of our interdisciplinary team, responsible for delivering high-quality, patient-centered care to critically ill patients. This role requires a proactive and collaborative approach, working closely with other healthcare professionals to ensure seamless care transitions and optimal...
-
Nurse Care Specialist
13 hours ago
Griffin, Georgia, United States CareMaster Medical Services Full timeJob DescriptionCareMaster Medical Services is seeking a highly skilled and compassionate Registered Nurse to join our team.Job Summary:We are looking for a dedicated and experienced Registered Nurse to provide high-quality patient care and support our medical team.Responsibilities:Provide exceptional patient care by assessing patient needs, developing...
-
Griffin, Georgia, United States Ennoble Care Full timeAbout UsEnnoble Care is a mobile healthcare service provider specializing in primary care, palliative care, and hospice services. Our team of clinicians delivers high-quality care to patients in their homes, focusing on those with chronic conditions and limited mobility. We offer a range of programs, including remote patient monitoring, behavioral health...
-
Home Health RN
5 days ago
Griffin, Georgia, United States Travel Nurse Source Full timeJob Title: Home Health RN - TravelerJob Type: Travel NursingLocation: Griffin, GAJob Description:About the PositionWe are seeking a skilled Home Health RN to join our team for a 13-week travel assignment in Griffin, GA. As a Home Health RN, you will provide high-quality patient care in the comfort of their own homes.ResponsibilitiesCompletes nursing...
-
LPN Nurse
5 days ago
Griffin, Georgia, United States Caring Hands United, Inc. Full timeJob Summary:Caring Hands United, Inc. is seeking a skilled and compassionate LPN Nurse to provide high-quality home care services to our clients. As a Home Care Specialist, you will be responsible for assessing patient needs, developing and implementing individualized care plans, and providing supervision and guidance to nursing assistants.Key...
-
Licensed Practical Nurse
5 days ago
Griffin, Georgia, United States Wellstar Health System Full timeJob SummaryThe Licensed Practical Nurse (LPN) plays a vital role in the delivery of high-quality patient care at Wellstar Health System. As a member of our interdisciplinary team, you will work under the direction of physicians, nurse supervisors, and practice managers to provide exceptional care to patients of all ages.Key ResponsibilitiesProfessional...
-
Senior Safety Officer
2 weeks ago
Griffin, Georgia, United States University of Georgia Full timePosition Overview The Senior Safety Officer plays a crucial role in maintaining the security and integrity of the University of Georgia's facilities. This position is responsible for ensuring the protection of university assets through vigilant monitoring and proactive measures. Key Responsibilities Surveillance: Conduct regular patrols of university...
-
Senior Project Manager
3 days ago
Griffin, Georgia, United States PBK Architects Full timeAbout the RoleWe are seeking a highly skilled and experienced Senior Project Manager to join our team at PBK Architects. As a Senior Project Manager, you will be responsible for overseeing the design and completion of architectural projects, ensuring that they are delivered on-time, on-budget, and to the highest quality standards.Key...
-
Griffin, Georgia, United States TravelNurseSource Full timeJob Title: Travel Nursing Home Health Care ProfessionalJob Description:TravelNurseSource is working with Core Medical Group to find a qualified Home Health RN for a travel assignment in a dynamic healthcare setting. As a travel allied professional or a traveling nurse with CoreMedical Group, you will have the opportunity to work with a reputable healthcare...
-
Travel Nurse RN
17 hours ago
Griffin, Georgia, United States Travel Nurse Source Full timeAbout the PositionType: Home HealthJob SummaryTravel Nurse Source is working with SkyBridge Healthcare to find a qualified Home Health RN for a 13-week contract. As a Home Health RN, you will provide high-quality patient care in a home setting, working closely with patients, families, and healthcare teams to develop and implement individualized care...
