Care Coordinator, Care Management

Hackensack Meridian Health - Edison, NJ

Full-time - Mid Level

Edison, NJ

Hospitals

About the position

The Care Coordinator, Care Management at Hackensack Meridian Health plays a crucial role in the healthcare team by coordinating and facilitating the clinical progression of patients' treatment and discharge plans. This position is responsible for managing a designated patient caseload, assessing needs, developing individualized care plans, and ensuring effective communication among healthcare team members to optimize patient care and transitions between services.

Responsibilities

• Assess patients by screening for potential discharge needs regardless of race, age, sex, religion, diagnosis, and ability to pay.
• Meet directly with patients/families to assess needs and develop individualized care plans in collaboration with the physician and other healthcare team members.
• Facilitate communication and coordination between healthcare team members, involving patients and families in the decision-making process.
• Maintain current information on community resources and refer patients to appropriate resources for their care.
• Consult with community agencies to identify potential resources to support patients and their families.
• Work collaboratively with multidisciplinary and post-acute care teams to secure timely transitions to the next level of care.
• Develop discharge plans in collaboration with patients and support persons, identifying goals for maximum benefit.
• Document and communicate information to the multidisciplinary team to coordinate and maximize care.
• Participate actively in committees, workgroups, and meetings.
• Identify and refer quality issues for review to the Quality Management Program.
• Participate in multidisciplinary rounds specific to assigned units, addressing issues impacting discharge and length of stay.
• Perform reassessments and evaluate progress against care goals, revising plans as needed.
• Provide patients and families with resources and discharge options, educating them on risks and benefits.
• Utilize social determinants of health screening tools during each intake assessment.
• Collaborate with the multidisciplinary team to support crisis intervention, counseling, and referrals.

Requirements

• Bachelor of Science in Nursing (BSN) or a Master's Degree in Social Work (MSW).
• Effective decision-making skills and creativity in problem-solving.
• Excellent verbal, written, and presentation skills.
• Moderate to expert computer skills, including familiarity with hospital and community resources.
• Proficient in Microsoft Office and Google Suite platforms.

Nice-to-haves

• Master's degree in a relevant field.
• Care Management, CCMA, or ACMA certification.

Benefits

• Competitive salary range of $60K - $75.9K per year.
• Comprehensive health insurance coverage.
• Support for continuing education and professional development.
• Flexible scheduling options.
• Employee wellness programs.