Care Coordinator Lead (RN) - Wiregrass Ranch Hospital, Wesley Chapel

Orlando Health•Wesley Chapel, FL

5h•Onsite

About The Position

Elevating Healthcare in Wesley Chapel and West Florida, Florida Medical Clinic Orlando Health Wiregrass Ranch Hospital is poised to revolutionize healthcare in Wesley Chapel and the broader West Florida region. This five-story, state-of-the-art multi-specialty hospital spans 380,000 square feet, purpose-built to serve one of Florida’s fastest-growing communities with exceptional, outcomes-focused care. Designed for Excellence: Opening with 102 beds, expandable to 300 beds at full build-out 9 advanced operating rooms, including a hybrid OR with real-time imaging capabilities Comprehensive services in cardiology, neurology, oncology, surgery, and more From life-saving procedures to advanced diagnostics, this facility is engineered to meet the evolving needs of our community with precision and compassion. Position Summary Collaborates with the assigned care coordination team to include clinical support, guidance, and educational direction while also identifying patients most likely to benefit from care coordination services to include assessing patients’ risk factors, the need for care coordination, clinical utilization management, and preventative care services

Requirements

Graduate of an approved school of nursing (RN), or a Master’s degree in Social Work (MSW), Mental Health (MHC) or Marriage and Family Therapy (MFT) from an accredited program.
Florida RN license required and maintained current if graduated from an approved school of nursing.
BLS/Healthcare Provider certification required within 90 days of hire.
Two (2) years of related healthcare experience and/or supervisory experience in the community with an emphasis on the population to be served in the assigned area.

Responsibilities

Takes the lead in ensuring the continuity and consistency of care across the continuum (inpatient, emergency, and ambulatory care/outpatient) to ensure integrated delivery across all settings to include the facilitation comprehensive discharge planning (in the hospital) and follow-up care (as an outpatient).
Develops an effective working relationship with the Licensed Mental Health Counselors/ Social Workers and the UR nurses to engage the patient/family to collaborate, advocate and problem solve, and to support and enhance their functional ability while ensuring an appropriate and timely discharge plan.
Assists in collaboration with the assigned team to identify patients most likely to benefit from care coordination services to include assessing the patient's risk factors and needs for care coordination, clinical utilization management services, and preventative services.
Serves as mentor to care coordination team through guidance, education, and motivation.
Daily monitoring of team performance and progress towards discharge plans and/ or need to alter discharge plan due to change in patient condition / family needs, with a priority placed on those patients at highest risk for complication/ admission/ readmission.
Develops collaborative relationships with the site patient care administrators, medical staff leadership, managed care contractors, and community leaders.
Ensures all patient care activities support established clinical standards of care and comply with various regulatory agencies and consider age specific, developmental, and cultural needs of the patient population served.
Promotes and models appropriate professional behavior as described in the Code of Conduct.
Demonstrates a passion forservice excellence and commitment to “Patient First” goals.
Achieves results by developing strategies to manage patient care across the continuum, focusing on high risk, high cost, and problem prone areas to include patient at risk for re-admission.
Supports processesfor clinical quality/ cost-improvement initiatives, preventing re-hospitalizations.
Builds and maintains effective partnership and relationships with other healthcare teams.
Conducts regular guidance and collaboration of team members.
Embraces, promotes, and communicates change.
Facilitates and supports team member involvement in professional and organizational activities.
Demonstrates professional accountability by maintaining proficiency in assigned role.
Holdsself and others accountable to Orlando Health’s mission, vision, and values.
Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options to include tracking patient progress towards care plan goals, and revising the care plan as indicated.
Advocatesfor patientsin orderto optimize their health care needsincluding but notlimited to safety, physical, legal, and financial well-being.
Monitors completion and compliance of discharge assessments.
Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA,and other federal, state, and local standards.
Maintains compliance with all Orlando Health policies and procedures.