JFK Johnson Rehabilitation Institute
CARE COORDINATOR, CARE MANAGEMENT
JFK Johnson Rehabilitation Institute, Laurelton, New Jersey, United States
Overview
Our team members are the heart of what makes us better. Care Coordinator, Care Management OCEAN MEDICAL CENTER Brick, New Jersey At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Care Coordinator, Care Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient\'s treatment and discharge plan. Accountable for a designated patient caseload; assesses, plans, and facilitates with patients, families and the multidisciplinary team to meet treatment goals, expected length of stay, and arrange for the appropriate next level of care. Oversees interfacility transitions and handoff between acute and post-acute services. Responsibilities
Assesses patients by screening for potential discharge needs and develops an individualized care plan in collaboration with the physician and health care team. Facilitates communication and coordination among health care team members, involving patient and family in decision making to minimize fragmentation of services and to manage resources. Maintains current information on community resources and refers patients to appropriate resources; consults with community agencies to identify resources to support patients and families. Works with multidisciplinary and post-acute care teams to secure timely transitions to the next level of care. Develops and communicates a discharge plan with goals that meet continuing care needs. Documents and shares information with the multidisciplinary team; ensures medical records reflect education, referrals, and authorizations. Participates in committees, rounds, and quality improvement activities; identifies quality issues for review and resolution. Performs reassessments and revises the plan as needed; ensures weekly discharge plan reassessment. Provides patients and families with discharge options and education on risks/benefits and available benefits. Provides CMS documents to patients/families as required by regulatory guidelines. Uses social determinants of health screening tools during intake assessments. Collaborates with the team to support crisis intervention, counseling, referrals, reporting abuse/neglect, guardianship, psychosocial assessments, and capacity management. Refers to appropriate facilities and services (e.g., acute care, rehabilitation, long-term care, home care, hospice, DME, transportation, palliative care, etc.). Maintains annual competencies and training in applicable platforms (Epic, Xsolis Cortex, BI, Google Suites). Other duties and/or projects as assigned and adheres to organizational standards. Qualifications
Education, Knowledge, Skills and Abilities Required
BSN or BSN in progress and/or willing to acquire within 3 years of hire or transfer; or Master\'s Degree in Social Work. Effective decision-making, problem-solving, and leadership skills. Excellent verbal, written and presentation skills. Moderate to expert computer skills; familiar with hospital and community resources and utilization management. Strong written and verbal communication skills; proficient with Microsoft Office and/or Google Suite. Education, Knowledge, Skills And Abilities Preferred
Master\'s degree. Licenses And Certifications Required
NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed Clinical Social Worker. Licenses And Certifications Preferred
Care Management, CCMA or ACMA certification strongly preferred. If you feel that the above description speaks directly to your strengths and capabilities, then please apply today! Compensation
Minimum rate of $9,075.04 Annually. HM H is committed to pay equity and transparency for our team members. The posted rate is a reasonable good faith estimate of the minimum base pay for this role at the time of posting and does not reflect the full value of our market-competitive total rewards package. Job Duties and Benefits
The starting rate of pay is for informational purposes only and is not a guarantee of a specific offer. Some jobs may be eligible for incentives, bonuses, or shift differentials. HM H offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, genetic information, disability, marital status, or status as a protected veteran. We keep getting better together. Stay connected with job openings and opportunities across the Hackensack Meridian Health network.
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Our team members are the heart of what makes us better. Care Coordinator, Care Management OCEAN MEDICAL CENTER Brick, New Jersey At Hackensack Meridian Health we help our patients live better, healthier lives — and we help one another to succeed. With a culture rooted in connection and collaboration, our employees are team members. Here, competitive benefits are just the beginning. It’s also about how we support one another and how we show up for our community. Together, we keep getting better - advancing our mission to transform healthcare and serve as a leader of positive change. The Care Coordinator, Care Management is a member of the healthcare team and is responsible for coordinating, communicating, and facilitating the clinical progression of the patient\'s treatment and discharge plan. Accountable for a designated patient caseload; assesses, plans, and facilitates with patients, families and the multidisciplinary team to meet treatment goals, expected length of stay, and arrange for the appropriate next level of care. Oversees interfacility transitions and handoff between acute and post-acute services. Responsibilities
Assesses patients by screening for potential discharge needs and develops an individualized care plan in collaboration with the physician and health care team. Facilitates communication and coordination among health care team members, involving patient and family in decision making to minimize fragmentation of services and to manage resources. Maintains current information on community resources and refers patients to appropriate resources; consults with community agencies to identify resources to support patients and families. Works with multidisciplinary and post-acute care teams to secure timely transitions to the next level of care. Develops and communicates a discharge plan with goals that meet continuing care needs. Documents and shares information with the multidisciplinary team; ensures medical records reflect education, referrals, and authorizations. Participates in committees, rounds, and quality improvement activities; identifies quality issues for review and resolution. Performs reassessments and revises the plan as needed; ensures weekly discharge plan reassessment. Provides patients and families with discharge options and education on risks/benefits and available benefits. Provides CMS documents to patients/families as required by regulatory guidelines. Uses social determinants of health screening tools during intake assessments. Collaborates with the team to support crisis intervention, counseling, referrals, reporting abuse/neglect, guardianship, psychosocial assessments, and capacity management. Refers to appropriate facilities and services (e.g., acute care, rehabilitation, long-term care, home care, hospice, DME, transportation, palliative care, etc.). Maintains annual competencies and training in applicable platforms (Epic, Xsolis Cortex, BI, Google Suites). Other duties and/or projects as assigned and adheres to organizational standards. Qualifications
Education, Knowledge, Skills and Abilities Required
BSN or BSN in progress and/or willing to acquire within 3 years of hire or transfer; or Master\'s Degree in Social Work. Effective decision-making, problem-solving, and leadership skills. Excellent verbal, written and presentation skills. Moderate to expert computer skills; familiar with hospital and community resources and utilization management. Strong written and verbal communication skills; proficient with Microsoft Office and/or Google Suite. Education, Knowledge, Skills And Abilities Preferred
Master\'s degree. Licenses And Certifications Required
NJ Licensed Registered Nurse or NJ Licensed Social Worker or NJ Licensed Clinical Social Worker. Licenses And Certifications Preferred
Care Management, CCMA or ACMA certification strongly preferred. If you feel that the above description speaks directly to your strengths and capabilities, then please apply today! Compensation
Minimum rate of $9,075.04 Annually. HM H is committed to pay equity and transparency for our team members. The posted rate is a reasonable good faith estimate of the minimum base pay for this role at the time of posting and does not reflect the full value of our market-competitive total rewards package. Job Duties and Benefits
The starting rate of pay is for informational purposes only and is not a guarantee of a specific offer. Some jobs may be eligible for incentives, bonuses, or shift differentials. HM H offers a comprehensive benefits package, including health, dental, vision, paid leave, tuition reimbursement, and retirement benefits. We are an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to age, race, color, creed, religion, sex, sexual orientation, gender identity or expression, pregnancy, genetic information, disability, marital status, or status as a protected veteran. We keep getting better together. Stay connected with job openings and opportunities across the Hackensack Meridian Health network.
#J-18808-Ljbffr