Care Coordination Specialist: Discharge & Case Management

St. Joseph's/Candler; Savannah (GA); On-site; USD 65,000 - 90,000; Full time

Job summary

St. Joseph's/Candler in Savannah, GA seeks a care coordinator to manage the process of assessing, planning, implementing, coordinating, monitoring, and evaluating health services for patients.

The role emphasizes discharge planning, readmission risk assessment, and collaboration with social workers throughout acute care stays. Responsibilities include daily discharge planning discussions with families, ensuring timely documentation, and active participation in multidisciplinary rounds to remove

Qualifications

• Brief assessment, readmission risk assessment, and 6-click mobility assessment within 1 business day of admission.
• Discuss discharge-planning needs with patient, family, and care team to coordinate resources.
• Reassess and document updates to discharge plan every 2 days with patient understanding or agreement.

Responsibilities

• Collaborates with Social Workers for complex-patient resolution and escalate barriers to leadership.
• Attend MDRs and provide GMLOS, actual LOS, and discharge date for daily review.
• Identify readmissions or high-risk cases and minimize avoidable days per procedure.
• Maintain communication with care team via voice mail and email at least every 2 hours; complete documentation by end of day.

Skills

Discharge planning

Readmission risk assessment

Care coordination

Collaboration

Documentation

Communication

Education

Bachelor's Degree in Nursing - Preferred

Master's Degree in Social Work - Preferred

Job description

St. Joseph's/Candler in Savannah, GA seeks a care coordinator to manage the process of assessing, planning, implementing, coordinating, monitoring, and evaluating health services for patients.

The role emphasizes discharge planning, readmission risk assessment, and collaboration with social workers throughout acute care stays. Responsibilities include daily discharge planning discussions with families, ensuring timely documentation, and active participation in multidisciplinary rounds to remove