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 effective discharge planning and care progression.
Key Duties:
- Conduct psychosocial, functional, and clinical assessments; develop individualized discharge plans; facilitate interdisciplinary care conferences and rounds.
- Collaborate with physicians, care teams, and patients to manage care progression, address barriers, and promote timely discharges.
- Coordinate post-acute referrals, evaluate social determinants of health, and ensure compliance with insurance and coverage requirements.
- Document assessments, care plans, and interactions accurately and timely in medical records.
- Identify and resolve delays in care, escalate barriers, and facilitate efficient resource utilization.
- Support professional development, serve as a mentor, and adhere to organizational policies and standards.
Qualifications & Skills:
- Associates or Bachelor’s Nursing degree preferred; valid RN license (single or multi-state compact); BLS certification.
- Minimum of 1 year nursing experience in an acute care setting.
- Excellent communication, organizational, and problem-solving skills; ability to work under pressure and in a fast-paced environment.
- Knowledge of healthcare regulations, community resources, and effective interdisciplinary collaboration.