POSITION SUMMARY

This position provides comprehensive care coordination for patients as assigned. The intensity of care coordination provided is situational and appropriate based on patient need and payer requirements. This position is accountable for clinical quality of Care Coordination services delivered by both them and others and identifies/resolves barriers which may hinder effective patient care. The goal is to empower the patient and the family to participate to the fullest of their abilities in the discharge planning process. This position provides developmentally appropriate care of the population that it serves which includes planning for a safe discharge, continuity of care, the ability to recognize and plan for the unique needs of all ages as well as the physically disabled, mentally ill, chronically ill and terminally ill patient.

CORE FUNCTIONS

1. Manages individual patients across the health care continuum to achieve the optimal...