RN Hospital Care Coordinator United Hospital
Core
Coordinates clinical transition planning and discharge for medically complex patients to prevent readmissions and ensure seamless post-discharge care.
Role type
Senior Registered Nurse Care Coordinator
Builds
Integrated, seamless post-discharge care pathways for complex patients
Domain
Healthcare / Hospital Care Management
Required skills
Clinical assessment, care planning, interdisciplinary collaboration, discharge coordination, resource management, regulatory compliance, utilization review, community resource navigation
Preferred skills
Case management certification, oncology certification, rehabilitation nursing certification, palliative care expertise
Technologies
Predictive tools, care management software, utilization criteria systems
Responsibilities
Complete clinical assessments and participate in patient care rounds, ensure timely progression of care and eliminate barriers, collaborate with healthcare team to plan transfers or discharge, assess clinical stability for discharge and oversee transition details, identify patients with complex discharge issues and coordinate rehab services, participate in transition conferences with patients and families, utilize tools to identify patients at risk for readmission and intervene, facilitate timely referrals and transfers of information, support level of care activities and utilization criteria, provide assistance for financial or social needs
Seniority
Senior, hands-on IC