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Patient Care Coordinator
2 months ago
Overview:
The Patient Care Coordinator (PCC) operates in partnership with patients, families, healthcare providers, and interdisciplinary teams to ensure seamless patient care from admission to discharge. The PCC is tasked with identifying, initiating, and managing optimal patient flow to enhance continuity of care, facilitate safe transitions, and improve patient satisfaction and safety. This role encompasses comprehensive assessment, planning, implementation, and evaluation of individual patient needs. Responsibilities include Care Coordination and Discharge Planning.
Key Responsibilities:
• Uphold the standards of OneCHRISTUS Competencies: Leader of Self, Leader of Others, or Leader of Leaders.
• Conduct interviews with patients and families to gather information regarding social, emotional, and financial factors that may affect health outcomes before and after discharge, while assessing the patient's current support systems and available resources.
• Collaborate with senior care managers to develop and monitor individualized care plans, ensuring the appropriateness and effectiveness of services.
• Facilitate patient care progression throughout the healthcare continuum in a cost-effective manner.
• Act as a resource and advocate for patients regarding treatment decisions and end-of-life considerations.
• Monitor patient length of stay and work with interdisciplinary team members to eliminate barriers and expedite discharge processes.
• Identify and escalate barriers to care and quality issues in a timely manner.
• Resolve delays to discharge effectively.
• Collaborate with medical, nursing, and ancillary staff to ensure efficient care delivery in the appropriate settings.
• Assess discharge planning needs and recommend post-acute care options, including:
• Rehabilitation Services
• Skilled Nursing Facilities
• Behavioral Health Services
• Home Health or Hospice Services
• Community Resources and Financial Assistance
• Legal and Advance Directive Support
• Ensure effective communication and documentation among patients, families, and healthcare team members to maintain continuity of care.
• Provide culturally sensitive interventions and support to diverse patient populations.
• Maintain consensus on care plans among patients, families, healthcare providers, and payors.
• Engage in multidisciplinary rounds to promote patient care progression.
• Document all interactions in accordance with regulatory and departmental guidelines.
• Commit to ongoing professional development and growth.
• Exhibit strong verbal and written communication skills, with the ability to engage with diverse populations.
• Demonstrate critical thinking and analytical skills.
• Exhibit clinical competency and the ability to multitask in a fast-paced environment.
• Possess knowledge of discharge planning, utilization management, and community resources.
• Work independently while exercising sound judgment in interactions with all stakeholders.
• Navigate the healthcare environment effectively throughout the workday.
Qualifications:
A. Education/Skills
- Required education includes:
- Certificate, Associate, or Bachelor's degree in Nursing
- Bachelor's or Master's degree in Social Work
B. Experience
- Preferred experience in clinical or acute care settings.
C. Licenses, Registrations, or Certifications
- Current licensure as LVN/LPN, RN, LBSW, LMSW, or LCSW in the state of practice is required.
- BLS certification preferred.
Work Schedule:
Varies
Work Type:
Per Diem As Needed
