Social Health Integrator (Reablement Coordinator)

NTUC HEALTH CO-OPERATIVE LTD; Singapore; On-site; SGD 48,000 - 72,000; Full time

Job summary

NTUC Health Co-operative Ltd is seeking a Reablement Coordinator to manage referrals and coordinate programme delivery across services. You will support and monitor participant progress throughout the reablement cycle, including caregiver training, to sustain independence and reduce hospital admissions.

Responsibilities include operational support, scheduling, InterRAI assessments, and data tracking for monitoring and reporting. Location includes Kampung Admiralty and Boon Lay.

Qualifications

• Relevant degree and experience in care coordination or rehabilitation services.
• Experience with InterRAI assessments and care planning preferred.
• Ability to liaise with therapists, caregivers and service staff.

Responsibilities

• Manage referrals and coordinate programme delivery across services with OT input.
• Monitor participant progress, support caregiver training, and ensure smooth transitions.
• Maintain programme documentation, scheduling, and data tracking for reporting.

Skills

Care coordination

Documentation

InterRAI assessments

Stakeholder communication

Education

Bachelor's degree in Healthcare/ Social Work

Tools

InterRAI Monitor

Scheduling software

Job description

The Reablement Coordinator manages referrals, coordinates programme delivery across services, supports and monitors participant progress throughout the reablement cycle, including caregiver training. This role aims to sustain long term independence and prevention of hospital admission of seniors. He/she will also provide operational and administrative support, including scheduling, documentation, InterRAI assessments, and data tracking for programme monitoring and reporting.

Key Responsibilities

1. 1) Programme delivery Work closely with occupational therapist (OT) to screen and triage referrals from various referral sources. Conduct functional screening, assessment and outcome measures, including InterRAI Monitor programme progress, recruitment numbers, and track milestones against the proposed timeline. Manage participant referrals and coordinate programme delivery across services, including working with service staff to ensure seamless care transitions. Deliver community integration interventions relating to the goals of the participants as prescribed by the OT Monitor participant progress throughout the reablement cycle and support caregiver training and reinforcement. Support transition to the next care service to ensure a warm handshake and smooth transition. Where required conduct home visits with OT or independently for follow ups.




2. 2) Care coordination Coordinate meetings with service staff and other stakeholders including caregivers Organise case discussion and conference between client, caregiver and care team Conduct regular review of intervention and progress of clients in existing services.




3. 3) Data collection, Reporting and administrative duties Manage programme documentation, including scheduling and coordination of case discussion and multidisciplinary meetings with other stakeholders, including clients and caregivers. Maintain accurate data tracking for programme monitoring, evaluation and reporting. Support other data collection such as post programme satisfaction survey, process survey to evaluate programme effectiveness. Any other duties as assigned by occupational therapist and reporting officer.

Key Deliverables

• Timely completion of screening and assessments


• Maintain 100% compliance in documentation and outcome tracking through the reablement cycle.


• Ensure all clinical matters, risk incidents are escalated and reported promptly to OT/Service staff.

Locations

Kampung Admiralty, Boon Lay