Care Management Navigator: Discharge & Transitions

Hackensack Meridian Health; Hackensack (NJ); On-site; USD 79,000 - 112,000; Full time

Job summary

Hackensack Meridian Health is seeking a Care Coordinator in Care Management to coordinate the clinical progression and discharge planning for a designated patient caseload. You will work with patients, families and the multidisciplinary team to meet goals, expected length of stay, and arrange appropriate next-level care.

You will ensure smooth interfacility transitions, document care, provide education, and participate in committees and rounds to improve patient outcomes.

Qualifications

• Bachelor's Degree in Nursing or related field, or Master's Degree in Social Work.
• Effective decision-making skills and problem-solving creativity.
• Excellent verbal, written and presentation skills.
• Moderate to expert computer skills.
• Familiar with hospital resources and utilization management.
• Proficient with Microsoft Office and/or Google Suite.

Responsibilities

• Coordinate discharge planning with patients and families and the care team.
• Facilitate communication to minimize fragmentation of services and manage resources.
• Refer patients to appropriate community resources and services.
• Collaborate with multidisciplinary teams for timely transitions to next care levels.
• Develop discharge plans and ensure ongoing care needs are met.
• Document care coordination activities and educate patients and families.
• Participate in committees, rounds, and quality improvement efforts.
• Identify quality issues and refer them to the Quality Management Program.
• Reassess progress and update discharge plans as medical conditions change.
• Provide information on CMS documents and health care benefits to patients.

Skills

Decision making

Creativity

Leadership

Communication skills

Computer skills

Utilization management

Education

Bachelor's Degree in Nursing or related field

Master's Degree in Social Work

Tools

Epic

Xsolis Cortex

BI

Google Suites

Job description

Hackensack Meridian Health is seeking a Care Coordinator in Care Management to coordinate the clinical progression and discharge planning for a designated patient caseload. You will work with patients, families and the multidisciplinary team to meet goals, expected length of stay, and arrange appropriate next-level care.

You will ensure smooth interfacility transitions, document care, provide education, and participate in committees and rounds to improve patient outcomes.