Coordinates the efforts of patient, family, and healthcare professionals to develop a plan of care across the continuum based on identified needs. Reviews and assesses the appropriateness of patient admissions and continued stays in accordance with established policies and procedures.
Responsibilities
- Ensures implementation of the prescribed plan of care in collaboration with patient/family and healthcare providers.
- Coordinates care and services across the continuum working directly with patient/ family, healthcare providers, staff, and payers.
- Evaluates and communicates patient progress towards established outcomes.
- Coordinates multi-disciplinary discharge planning to assess current and discharge needs.
- Evaluates patient satisfaction and quality of care provided.
- Provide post-discharge follow-up to ensure the progress of the discharge plan.
- Promotes quality and cost-effective interventions, resources, and outcomes utilizing a multidisciplinary team approach.
- Reviews and determines necessity and appropriateness of hospitalization using established criteria to prevent denials of payment.
- Refers appropriate cases to the physician advisor for intervention.
- Serves as a liaison with healthcare providers, admissions, and medical records staff to assure continuity of patient care, discharge planning, and effective communications.
- Arranges appropriate referrals for counseling, financial assistance, and discharge planning assistance as needed.
- Assists in the collection, delivery, and tracking of information for Performance Improvement, Risk Management, and Infection Control.
Qualifications
Education:
- Associate's Degree: Graduate of an accredited program in nursing
Experience:
- 3 years of clinical experience as a registered nurse in an acute care facility
Skills:
- Excellent customer service and communication skills
- Strong organizational and problem-solving skills
- Advanced statistical and spreadsheet/database application skills
