Care Coordinator, Care Management

Hackensack Meridian Health • Hackensack, NJ

94d • $95,555

About The Position

The Care Coordinator, Care Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient's treatment and discharge plan. Accountable for a designated patient caseload; assesses, plans, and facilitates with patients, families and the multidisciplinary team to meet treatment goals, expected length of stay, and arrange for the appropriate next level of care. Oversees interfacility transitions and handoff between acute and post-acute services.

Requirements

• BSN or BSN in progress and/or willing to acquire within 3 years of hire or transfer into the position; or Masters Degree in Social Work.
• Effective decision-making skills, demonstration of creativity in problem-solving, and influential leadership skills.
• Excellent verbal, written and presentation skills.
• Moderate to expert computer skills.
• Familiar with hospital resources, community resources, and utilization management.

Nice To Haves

• Master's degree.
• Care Management, CCMA or ACMA certification strongly preferred.

Responsibilities

• Assesses patients by screening for potential discharge needs regardless of race, age, sex, religion, diagnosis and ability to pay.
• Meets directly with patient/family to assess needs and develop an individualized care plan in collaboration with the physician and other members of the health care team.
• Facilitates communication and coordination between members of the health care team and involves the patient and family in the decision making process.
• Maintains current information of community resources and refers patients to those community resources appropriate for the patient's care.
• Works collaboratively with all team members of the multidisciplinary and post acute care teams to secure timely and appropriate transitions to the next level of care.
• Develops a discharge plan, in collaboration with the patient and support persons, identifying goals that will provide maximum benefit for each patient.
• Documents and communicates information to the multidisciplinary team in order to coordinate and maximize care.
• Participates actively on appropriate committees, workgroups, and or meetings.
• Identifies and refers quality issues for review to the Quality Management Program.
• Participates in multidisciplinary rounds, specific to assigned units.
• Performs appropriate reassessments and evaluates progress against care goals and the plan of care and revises plan, as needed.
• Provides patients and families with resources and discharge options.
• Provides appropriate CMS documents to the patient and family/support person as per regulatory guidelines.
• Utilizes social determinants of health screening tools and resources during each intake assessment.
• Collaborates with all members of the multidisciplinary team to support various functions including crisis intervention, counseling support and referrals.
• Maintains annual competencies and ensures training and continuing education of the team in applicable platforms.

Benefits

• Health insurance
• Dental insurance
• Vision insurance
• Paid leave
• Tuition reimbursement
• Retirement benefits

What This Job Offers

• Education Level: Bachelor's degree
• Number of Employees: 5,001-10,000 employees