Summary:

Responsible for partnering with the physician and multidisciplinary team in coordinating patient care with the underlying objective of enhancing quality and cost effective care. Acts as a resource and patient advocate to facilitate a safe transition across the continuum.

Position Responsibilities:

Care Coordination – completes appropriate assessments and plans effectively to meet patient needs, monitors the length of stay and promotes efficient utilization of resources. Acts as a clinical expert and maintains ongoing knowledge of clinical practice guidelines. Engages the physician and builds seamless continuity of care and is the physicians single consistent resource. Problem resolution, patient/family communication. Helps identify factors impeding patient progression, resolves, escalates and documents as appropriate. Refers appropriate cases for Social Work intervention.

Documentation – Appropriate and compl...