Registered Nurse (RN) -Care Coordination FT Days

Come join our Cobb Hospital Care Coordination team at Wellstar, where your contributions and ideas are valued, and you can serve with compassion, pursue excellence, and honor every voice. Our mission is to enhance the health and well-being of every person we serve.

About the Facility

Learn more about Wellstar Cobb Hospital, including our teams, culture, and campus environment: Wellstar Cobb Hospital.

Hours: Full-time, Days, Monday–Friday.

Sign-on bonus and relocation assistance available for eligible candidates.

About the Role

The Care Coordinator RN (CC RN) is responsible for assessing transitional care needs, coordinating care across the continuum, and engaging with patients and families to ensure care needs are met. The role integrates care facilitation, care progression, and transitional care planning to manage length of stay and promote efficient resource utilization.

Responsibilities

• Conduct psychosocial and functional status assessments, transitional care planning, and patient/family education.
• Collaborate with the utilization review nurse, physicians, and interdisciplinary care team to assess medical, psychosocial, and social determinants of health needs, as well as continued care requirements.
• Ensure patients progress toward discharge goals and assist in removing barriers.
• Consult with appropriate disciplines to proactively resolve delays and expedite care.
• Manage all aspects of discharge planning, including developing individualized plans in collaboration with physicians and care teams.
• Identify and document barriers to timely disposition and ensure consensus on discharge plans with all stakeholders.
• Participate in interdisciplinary rounds to confirm estimated discharge dates and recommend optimal care transitions.
• Initiate and facilitate post-acute referrals for timely transitions to the next level of care.
• Refer cases for social work intervention as needed, respecting cultural or religious beliefs.
• Collaborate with physicians and care teams to facilitate care progression and address delays in diagnostics or treatments.
• Identify and discuss medical necessity for inpatient vs. outpatient testing with physicians.
• Resolve barriers to discharge and escalate issues to leadership as needed.
• Complete and document initial clinical/psychosocial assessments in the medical record.
• Maintain clear, concise, and up-to-date documentation of interactions with patients, families, physicians, and community partners.
• Track avoidable days and report trends leading to undesired outcomes.
• Complete professional competency assessments, mandatory education, and population-specific training.
• Support departmental and organizational goals, and serve as a preceptor/mentor for student interns if applicable.
• Perform other duties as assigned and comply with Wellstar Health System policies and standards.

Requirements

• Associate’s degree or diploma in Nursing (Bachelor’s preferred).
• Current RN license (Single State or Multi-state Compact).
• Basic Life Support (BLS) certification (American Red Cross or equivalent).
• Minimum of 1 year of nursing experience in an acute care setting.

Skills

• Excellent written and verbal communication.
• Self-directed, mature, and able to function well under stress and in fast-paced environments.
• Strong assessment, interview, organizational, and problem-solving skills.
• Knowledge of local, state, and federal regulations, as well as community and statewide resources.
• Ability to collaborate with physicians, care teams, and patients/families to facilitate care transitions.