Rn Care Coordinator Jobs

About The Position

Requirements

• Bachelor's degree in Nursing, Associate degree in Nursing, or Nursing diploma.
• Current RN license (single-state or multistate compact).
• BLS certification, including an accepted equivalent listed in the posting.
• At least 3 years of healthcare experience in an acute care setting, related field, skilled care, or community environment in care coordination.
• At least 2 years of care coordination experience in an acute care setting.
• Excellent written and verbal communication skills.
• Maturity, self-confidence, objectivity, and a positive attitude.
• Ability to work independently, handle stress and change, and function in a fast-paced environment.
• Strong assessment, interviewing, organizational, and problem-solving skills.
• Knowledge of local, state, and federal regulations.
• Knowledge of community and statewide resources and programs.
• Ability to collaborate with physicians, care team members, and patients and families across the continuum of care.

Responsibilities

• Coordinate clinical discharge planning and patient progression toward clinical and discharge milestones.
• Consult and collaborate in real time with ED and admitting providers regarding admission and documentation.
• Complete initial assessments and progression-of-care documentation in a timely manner.
• Identify, document, and escalate barriers or delays affecting disposition, throughput, and length of stay.
• Implement discharge planning and provide timely resource information for complex patients.
• Understand eligibility processes and criteria for private and public local, state, and federal resources to support safe transitions.
• Respond to patient-assistance referrals from nurses, physicians, and the care team.
• Participate in interdisciplinary rounds, confirm estimated discharge dates, and recommend appropriate levels of care at discharge.
• Initiate and facilitate post-acute referrals through departmental processes.
• Assess financial needs for patients requiring assistance with follow-up care throughout the continuum.
• Partner with patients and families to support autonomous healthcare decisions and keep patient wishes central to discharge planning.
• Arrange and facilitate family meetings when needed, and account for cultural or religious beliefs in care planning.
• Assess psychosocial risk factors and availability of discharge resources based on preliminary screening.
• Partner with the PAS, financial counselor, and/or UM nurse to assess insurance and coverage requirements.
• Collaborate with patients, families, physicians, and other care team members to support care progression and discharge plans.
• Maintain current, understandable medical-record documentation, including assessments, progress notes, interactions, services arranged or delivered, and avoidable days when applicable.
• Maintain competency in Utilization Management and Clinical Documentation Integrity and collaborate with those teams on patient status, medical necessity, and documentation accuracy.
• Maintain working knowledge of organizational priority DRGs and quality indicators, and support denial prevention and efficient resource utilization.
• Lead and help facilitate interdisciplinary rounds and daily progression huddles; coordinate work among the SWCC and CMA.
• Serve as a clinical resource to nursing staff, providers, and ancillary departments on discharge planning and care coordination.
• Promote accountability for discharge readiness and transition planning activities.
• Complete required competency assessments and education, support departmental goals, and participate in protocols, procedures, and performance improvement.
• Assist leadership with precepting new hires, mentor newer employees, and serve as a preceptor or mentor for student interns.
• Perform other duties as assigned and comply with Wellstar Health System policies, standards of work, and code of conduct.