Coordinate the overall interdisciplinary plan of care for patient, from admission to discharge. Create plan for care across the continuum, integrating patient/family preferences and values. Serve as a resource to assess, evaluate, recommend and treat legal, neglect, substance abuse, crisis, psychosocial and various adjustment needs Advocate for resources and removal of barriers. Maintain ongoing dialog with supervisor and care transition team members to ensure effective implementation and re-evaluation of health plan. Act as a resource for adequate medical record documentation, complex level of care recommendations, and services as they relate to diagnoses, and treatment options for post-discharge care. Why Join Our Team Ascension Saint Thomas is a leading health care system with a 125-year history of providing care to the community, and is the only faith-based, non profit health system in Middle Tennessee. Today, the health system offers a highly comprehensive system of care, consisting of a network of hospitals, affiliated joint ventures, medical practices, clinics and specialty facilities. Ascension is a leading non-profit, faith-based national health system made up of thousands of associates delivering compassionate, personalized care across hospitals, clinics and senior living communities. Our Mission, Vision and Values encompass everything we do at Ascension. Every associate is empowered to give back, volunteer and make a positive impact in their community. Ascension careers are more than jobs; they are opportunities to enhance your life and the lives of the people around you.
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Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
Number of Employees
5,001-10,000 employees