Care Coordinator
Rex Healthcare - Raleigh, NC

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Essential Duties and Responsibilities are as follows. Other duties may be assigned.


Essential Duties and Responsibilities



Maintains an environment of safety for patients, self and others.


Actively leads or participates in departmental, service line and/or organization quality improvement initiatives to ensure patient, departmental and organizational goals/outcomes are met or exceeded.


Reports issues and system barriers for efficient and effective transition management to a member of the Leadership/Management team per policy





Care Coordination, Discharge Planning and Psycho-Social Support


Essential Duties and Responsibilities



Performs comprehensive Case Management Screen/Assessment for all patients per departmental policy and appropriately identifies potential discharge planning and/or psycho-social needs


Partners with the physicians and interdisciplinary team to coordinate patient’s discharge plan to ensure all critical elements have been addressed and patient is moved to the appropriate next level of care.


Utilizes critical thinking skills to proactively identify and appropriately address medically complex and/or psychosocial related discharge planning barriers


Actively participates in Complex Care Rounds, Daily Huddles and Interdisciplinary rounds to address identified barriers so that patient can be moved through the care continuum in a timely manner.


Initiates and facilitates referrals for post-acute care to include home health, DME, infusion, Rehab Placement, Hospice and others in a timely manner and is knowledgeable of post-acute benefits.


Collaborates with the Utilization Managers to ensure congruence among the patient’s condition, physician’s level of care order and billing status.


Adheres to all pertinent regulatory guidelines from various federal, state and professional agencies related to care coordination and discharge planning. (CMS Conditions of Participation and Joint Commission)


Monitors appropriate outcome metrics such as length of stay, readmissions and avoidable delays. Involved in process improvement initiatives to develop strategies to improve outcomes.


Communicates care coordination involvement through thorough documentation in the electronic medical record and by verbal interactions with the physician, interdisciplinary team, patient and family.

Job Qualifications:

Minimum 2 years experience in Acute Care Hospital Case Management highly desired. Equivalent experience may be considered.


Master's degree in Social Work (MSW) or Registered Nurse with minimum of Bachelor's degree in Nursing (BSN) from an accredited college/university is required. Other licensed healthcare professionals may be considered.”


Special Skills


Valid North Carolina Nursing License for any BSN.

Reporting Relationships

Does this position formally supervise employees?


If set to YES, then this position has the authority (delegated) to hire, terminate, discipline, promote or effectively recommend such to manager.

Rex Healthcare - 4 months ago - save job - - block
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About this company
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Rex is a king of health care in Raleigh. Part of the  UNC HealthCare System, Rex Healthcare is a not-for-profit health care provider that...