San Diego , California
Linthicum, Maryland
Suffern, New York
Cheyenne, Wyoming
Bowling Green, Kentucky
Hawaii
San Antonio, Texas
Hershey, Pennsylvania
Posted: 13-Mar-25
Location: Greenwood Village, Colorado
Internal Number: 25010030
Registered Nurse Care Coordinator – PorterCare AH System
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Career Development
- Whole Person Wellbeing Resources
- Mental Health Resources and Support
Our promise to you:
Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full Time
Shift: Monday - Friday Day Shift
Location: – covering Adams, Arapahoe, Jefferson, Denver, Douglas, Elbert and Elizabeth Counties.
The role you’ll contribute:
The Connected Care Coordinator will function as the key patient advocate and educator for coordination of post-acute care services within AdventHealth (AH) owned hospitals. This person will assist in assessing patients for post-acute care, coordinating the clinical transition to home health and hospice as clinically indicated and into the appropriate post-acute setting. The Coordinator is responsible for maintaining relationships with physicians, post-acute providers, therapists, patients and families. This Coordinator will be assigned a specific hospital or specialty and is responsible for collaboration with care management, the physicians, and the clinicians to develop a discharge plan requiring post-acute services across AdventHealth continuum of care.
The value you’ll bring to the team:
- Responsible for conducting a systematic post-acute assessment of the physical, psychosocial and functional aspects of the patient and his/her family and their impact on the outcome potential to determine appropriateness for the Home Health and Hospice care setting.
- Inform and educate the patient and family about these post-acute settings, balancing the patient/family requests with what is required to provide safe, reliable, ongoing care for the patient.
- Identify patient/family problems or needs ensuring communication to physician, care management and the clinical team.
- Assist with coordination of home health care referrals within assigned hospital(s). May conduct bedside assessment to determine appropriateness of home or hospice care admission and educates patient/family regarding discharge plan and home care and hospice service expectations.
- After receiving Referral, assist with Intake process including pre-registration requirements for HHC admission.
- Maintains comprehensive working knowledge of managed care along with community resources.
- Completes and submits all documentation in a timely manner according to department policy.
- Responsible for reviewing the discharge plan with Care Management and the clinical transition team from inpatient to post-acute care ensuring systematic handoff between care providers.
- May participates in MDR, care conferences and coordination with Case Management.
- Strictly adhere to mandated federal, state, local regulatory and statutory requirements as well as AH policies and procedures for referral processing.
- Develop a presence inside the Hospital medical community, confer with health care providers, promote educational opportunities as they present, and attend meetings as assigned.
- Attends in-service training and mandatory company meetings
- Perform other duties as assigned by management.
- Collaborate with Care Management on patient readmission assessments.
The expertise and experiences you’ll need to succeed:
Minimum qualifications:
- Associate in Nursing or above
- Minimum two years of post-acute (e.g., home health and/or skilled nursing facility and/or hospice clinical experience) or Care Management in a facility experience
- Experience working with the public and exceptional customer service skills
- Knowledge of medical terminology and the post-acute referral process
- Registered Nurse
- AHA Basic Life Support certification
- Valid Colorado driver’s license, automobile insurance, safe driving record and reliable transportation
Preferred qualifications:
- Bachelor’s degree in medical related field
- Bachelors of Nursing
