Care Coordinator, Acute SW - Baptist Health- Princeton

Overview

Department
:
Care Management

Shift
:
Day Shift / FT

Location
:
Baptist Health Princeton

Title
:
Care Coordinator, Acute SW II

Summary
:
Collaborates with the assigned clinical team to identify patients most likely to benefit from care coordination services, including assessing patients’ risk factors and need for care coordination, clinical utilization management, and preventive care services.

Orlando Health is Your Best Place to Work is our promise to you and reflects our commitment to a diverse and inclusive team. You are welcome here regardless of your background or beliefs.

ORLANDO HEALTH - BENEFITS & PERKS:

• Competitive Pay

All Inclusive Benefits (start day one)

• Student loan repayment, tuition reimbursement, FREE college education programs, retirement savings, paid paternity leave, fertility benefits, back up elder and childcare, pet insurance, PTO/Holidays, and more for full time and part time employees.

Forbes Recognizes Orlando Health as a Best-In-State Employer

• Forbes named Orlando Health as one of America's Best-In-State Employers for 2021. Orlando Health is the top healthcare organization in the Metro Orlando area on the list.

Employee-centric

Orlando Health has been selected as one of the “Best Places to Work in Healthcare” by Modern Healthcare.

Essential Functions

• Takes the lead in ensuring continuity and consistency of care across the continuum (inpatient, emergency and ambulatory care/outpatient) to ensure integrated delivery and facilitate comprehensive discharge planning (in the hospital) and follow-up care (outpatient).
• Develops effective working relationships with the Patient and Family Counselors/Social Workers and UR nurses to engage the patient/family to collaborate, advocate and problem solve, supporting and enhancing functional ability while ensuring an appropriate and timely discharge plan.
• Monitors daily progress toward discharge plans and adjust as needed due to changes in patient condition or family needs, prioritizing high-risk patients.
• Educates patients/families with chronic illness about evidence-based standards of care and self-management strategies.
• Identifies support needs for patients and families, develops action plans, and provides guidance in initiating and overcoming self-management strategies.
• educates patients and families about the health care system and facilitates relationship building between settings.
• Ensures patients have access to prescriptions, durable medical equipment (DME), and other identified services.
• Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus, and evaluating outcomes of treatment options, including tracking progress toward care plan goals and revising the care plan as indicated.
• Advocates for patients to optimize health care needs, including safety, physical, legal and financial well-being.
• Refers patients to education regarding the healthcare delivery and reimbursement systems, prescription drug programs, health & wellness programs, community services and housing options as appropriate.
• Works with IT resources (i.e., Phytel, Crimson) to facilitate registry reporting and maintenance of specified patient populations to improve disease outcomes through guidelines and clinical decision support tools, tracking, and preventive reminders.
• Participates in clinical outcome measurement and identifies strategies that promote population health.
• Ensures patient safety in performance of job functions by implementing policies, procedures and standards.
• Maintains regular, punctual attendance consistent with applicable policies and standards.
• Maintains compliance with all Orlando Health policies and procedures.

• Provides clinical treatment interventions under supervision of licensed Mental Health Therapist, facilitating psychosocial adjustment and transition to next level of care.
• Participates in facilitation of psychosocial support groups.
• Provides mental health education and information for patients and families.
• Demonstrates analytical and teamwork skills, with ability to prioritize and work independently.
• Demonstrates age-appropriate care knowledge across the life span and awareness of medical/legal issues, patient rights, and regulatory standards.
• Performs other duties as assigned or required.

Education/Training
Master’s degree from an accredited school of Social Work, Mental Health, Psychology or Marriage and Family Therapy is required.

Licensure/Certification
Handle with Care (HWC) Certification required for Behavioral Health Unit.

Experience
Must have two (2) years of direct clinical experience with emphasis on the population served in the assigned area. Successful completion of Master’s level internship may substitute for the two (2) years of experience.