Care Coordination RN: Transitional Care & Discharge Planner

Wellstar Health System, Inc.; Hephzibah (GA); On-site; USD 65,000 - 95,000; Full time

Job summary

Wellstar Health System, Inc. is seeking a Care Coordinator RN to assess transitional care needs, coordinate across the continuum, and engage with patients and families to ensure care needs are met.

The CC RN plans effectively to meet patient needs, manage length of stay, and promote efficient utilization of resources, coordinating care progression and discharge planning with the care team. Responsibilities include psychosocial and functional assessments, discharge planning, documentation,

Qualifications

• Strong written and verbal communication.
• Ability to work with physicians and care team during transitions.
• Knowledge of discharge planning and care transitions.
• Familiarity with social determinants of health and community resources.

Responsibilities

• Assessment of chronic disease management needs and psychosocial risk factors.
• Partner with PAS, financial counselor and UM nurse to assess insurance and coverage requirements.
• Collaborate with patient, family and care team to establish and support discharge plans.
• Manage discharge planning and ensure timely execution of resources and referrals.

Skills

Communication skills

Interdisciplinary collaboration

Documentation and record-keeping

Clinical nursing knowledge

Discharge planning

Education

Associates Nursing or Diploma (Nurse) Nursing or Bachelors Nursing-Preferred

Job description

Wellstar Health System, Inc. is seeking a Care Coordinator RN to assess transitional care needs, coordinate across the continuum, and engage with patients and families to ensure care needs are met.

The CC RN plans effectively to meet patient needs, manage length of stay, and promote efficient utilization of resources, coordinating care progression and discharge planning with the care team. Responsibilities include psychosocial and functional assessments, discharge planning, documentation,