Role: Care Coordinator RN (CC RN) responsible for assessing transitional care needs, coordinating care across the continuum, and engaging with patients and families to ensure comprehensive care and smooth discharge planning.
Responsibilities: Conduct psychosocial and functional assessments, develop individualized discharge plans, collaborate with interdisciplinary teams, facilitate patient/family education, and manage post-acute referrals. Identify and resolve barriers to timely discharge, monitor care progression, and ensure accurate documentation of all interactions and plans. Support care progression by addressing delays and obstacles proactively, and participate in interdisciplinary rounds and care conferences.
Qualifications & Skills: Requires RN license (single or multi-state), BLS certification, minimum one year of acute care nursing experience, and excellent communication skills. Must be self-directed, organized, capable of handling stress, and knowledgeable of healthcare regulations and community resources. Demonstrates maturity, confidence, and a collaborative approach to patient care.
Additional Duties: Complete ongoing professional development, support departmental goals, and serve as a mentor if applicable. Adheres to organizational policies and standards.