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Live Well Homecare Agency, LLC seeks a Care Coordinator RN (CC RN) to assess transitional care needs and manage care coordination across the continuum, engaging patients and families to ensure care plans are met.
The role includes conducting psychosocial assessments, collaborating with interdisciplinary teams to develop discharge plans, educating patients and families, and addressing barriers to timely discharge. Strong documentation and post-acute coordination are essential.
The Care Coordinator RN (CC RN) assesses transitional care needs, manages care coordination across the continuum, and engages patients and families to ensure care plans are met.
Conducts psychosocial and functional assessments, collaborates with interdisciplinary teams to develop and implement discharge plans, facilitates patient/family education, and addresses barriers to timely discharge. Manages all aspects of discharge planning, including post-acute referrals and resource coordination. Ensures accurate documentation of assessments, care progression, and discharge plans, and supports continuous professional development.
Requires an RN license (single or multi-state), BLS certification, and at least 1 year of acute care nursing experience. Must possess excellent communication, organizational, and problem-solving skills, with the ability to work collaboratively in a fast-paced environment. Knowledge of healthcare regulations, community resources, and patient-centered care principles is essential.
Assess patient needs, coordinate interdisciplinary care, facilitate efficient discharge processes, identify and resolve care barriers, and maintain thorough documentation to promote optimal patient outcomes.