Care Coordinator RN

Job Summary

You will be a central figure in patient care, seamlessly navigating the healthcare journey to achieve optimal outcomes and an exceptional patient experience. Every day, you will strategically assess, plan, and facilitate comprehensive care across the continuum, expertly advocating for patients while collaborating with physicians, nursing, departments, insurers, and post-acute providers to ensure timely, high-quality transitions.

Responsibilities

• Completes and documents a discharge planning assessment on those patients identified by the designated screening process, or upon request.
• Reassesses the patient as appropriate and updates the plan accordingly.
• Facilitates the development of a multidisciplinary discharge plan, engaging other relevant health team members, the patient and/or patient representative, and post-acute care providers in accordance with the patient’s clinical or psychosocial needs, choices, and available resources.
• Oversees and evaluates the implementation of the discharge plan.
• Collaborates with the multidisciplinary team to ensure progression of care and appropriate utilization of inpatient resources using established evidence-based guidelines/criteria.
• Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon the patient’s clinical needs.
• Identifies risk for readmission and implements interventions to mitigate those risks for at least a 30-day period.

Requirements

• Minimum Graduate of an accredited school of nursing
• Minimum two (2) years of acute hospital clinical experience or a Masters degree in Case Management or Nursing field in lieu of one (1) year experience
• California RN license
• Basic Life Support - CPR (BLS-CPR) within 90 Days
• PREFERRED: Graduate of an accredited school of nursing (Bachelor's Degree in Nursing (BSN)) or related healthcare field
• At least five (5) years of nursing experience
• Certified Case Manager (CCM), Accredited Case Manager (ACM-RN), or UM Certification preferred
• Knowledge of managed care and payer environment preferred
• LA City Fire Card required within 90 days of hire
• Able to pass annual Inter-rater reliability test for Utilization Review product(s) used
• Must have critical thinking and problem-solving skills
• Collaborate effectively with multiple stakeholders
• Professional communication skills
• Understand how utilization management and case management programs integrate
• Ability to work as a team player and assist other members of the team where needed
• Thrives in a fast-paced, self-directed environment
• Knowledge of CMS standards and requirements
• Proficient in prioritizing work and delegating where indicated
• Highly organized with excellent time management skills
• Excellent customer service and presentation skills are a must
• Strong interpersonal and written communication skills are essential
• Demonstrated ability to apply analytical and problem-solving skills
• Demonstrated ability to manage multiple tasks or projects