Care Coordinator, Care Management Specialist
2 months ago
We are seeking a highly skilled and compassionate Care Coordinator to join our team at Hackensack Meridian Health. As a key member of our healthcare team, you will play a vital role in coordinating, communicating, and facilitating the clinical progression of patient treatment and discharge plans.
Responsibilities- Assessment and Planning: Assess patients' needs, develop individualized care plans, and collaborate with physicians and healthcare teams to ensure seamless care transitions.
- Communication and Coordination: Facilitate communication between healthcare teams, patients, and families to minimize fragmentation of services and ensure timely transitions to the next level of care.
- Community Resource Referral: Maintain current information on community resources and refer patients to those resources that best meet their needs.
- Discharge Planning: Develop discharge plans that meet patients' continuing care needs, ensuring a smooth transition to the next level of care.
- Documentation and Communication: Document and communicate information to healthcare teams to coordinate and maximize care, ensuring the medical record reflects education provided, coordination of services, referrals made, and authorizations obtained.
- Quality Improvement: Identify and refer quality issues for review to the Quality Management Program, participating in multidisciplinary rounds and bringing forth issues impacting discharge and length of stay.
- Patient Education and Support: Provide patients and families with resources and discharge options, educating them on the risks and benefits of discharge options and available healthcare benefits.
- Regulatory Compliance: Provide patients and families with CMS documents as per regulatory guidelines, utilizing social determinants of health screening tools and resources during each intake assessment.
- Collaboration and Referral: Collaborate with healthcare teams to support crisis intervention, counseling support, and referrals, abuse and neglect reporting, adoption planning, guardianship, psychosocial assessments, observation management, capacity management, hospital throughput, and other functions as required.
- Education and Experience: BSN or BSN in progress, or Masters Degree in Social Work, with effective decision-making skills, demonstration of creativity in problem-solving, and influential leadership skills.
- Skills and Abilities: Excellent verbal, written, and presentation skills, moderate to expert computer skills, familiarity with hospital resources, community resources, and utilization management, and proficiency in Microsoft Office and/or Google Suite platforms.
- Required: NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed Clinical Social Worker.
- Preferred: Care Management, CCMA, or ACMA certification.
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