Care Coordinator

7 days ago

Cambridge, Massachusetts, United States Spaulding Hospital-Boston & Cambridge(SRN,SRH,SHC) Full time
Job Summary

Spaulding Rehabilitation is seeking a skilled Care Coordinator to facilitate the coordination of care for patients, from admission through discharge. The ideal candidate will have a strong background in case management, utilization review, or discharge planning, with experience in an acute, rehabilitation, skilled nursing, or outpatient setting.

Key Responsibilities
  • Conduct assessments of patients' health and psychosocial needs, per established guidelines.
  • Develop and implement case management plans collaboratively with the interdisciplinary team, patient, and family to maximize healthcare responses, quality, and cost-effective outcomes.
  • Promote communication and coordination between members of the interdisciplinary team, payers, and the community to minimize fragmentation of services and maximize outcomes.
  • Plan and conduct patient-centered team meetings to coordinate healthcare team members and third-party payers to achieve treatment outcomes and discharge planning goals.
  • Provide education to the interdisciplinary team, patient, and family about treatment options, community resources, insurance benefits, and psychosocial concerns to ensure timely and informed decisions.
  • Empower patients and families to problem-solve and achieve desired outcomes, promoting patient self-determination.
  • Encourage the appropriate use of healthcare services and allocation of resources to improve quality of care and maintain a balance with cost-effective care on a case-by-case basis.
  • Identify and provide access to appropriate resources to promote a safe transition to the next most appropriate level of care.
  • Develop discharge plans in collaboration with the healthcare team and family, meeting patient needs and financial requirements.
  • Provide culturally competent care, identifying patients' cultural needs and incorporating them into the development of the discharge plan.
  • Ensure a smooth transition from the acute setting, through the SRN stay, and to discharge, using established standards.
  • Document all activities in adherence to department standards.
  • Adhere to third-party coverage guidelines for each patient situation.
  • Complete additional department, organization, or network activities per established objectives.
  • Uphold the organizational values of Innovation, Collaboration, Accountability, Respect, and Excellence.
Qualifications
  • Education: Bachelor's Degree in a related field. Master's Degree in a related field is preferred.
  • Experience: 3-5 years of related experience. Case management, utilization review, or discharge planning experience in an acute, rehabilitation, skilled nursing, or outpatient setting is required.
  • Licensure: Current, unrestricted license to practice in Massachusetts in a health or human services discipline that allows the professional to conduct an assessment independently, as permitted within the scope of practice of the discipline.
  • Skills: Knowledge of community services and the healthcare system, knowledge of criteria and levels of care, computer proficiency, and Microsoft Office applications.

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