Coordinates and facilitates patient care across a multidisciplinary care continuum within a clinical service unit structure. Ensures optimum utilization of resources, service delivery and compliance with clinical cost education initiatives. Secures best possible outcomes for our patients by being advocates and resource managers to facilitate patient centered solutions.

1. Maintains appropriate documentation

• • Assesses and evaluates patients’ ability to provide self care; develops discharge plan and goals of care with patient and involved caregivers.
  • Assists with making referrals to related agencies taking into consideration freedom of choice.
  • Provides information to social service/discharge planners to facilitate discharge planning process.
  • Participates in multidisciplinary rounding and care conferences with other departments.
  • Serves as a resource person to physicians and hospital staff in the appropriate use of health care resources.
  • Serves as a liaison with nursing and medical staff and community agencies to facilitate problem solving and to coordinate services.
    
    

2. Assesses and develops plan early upon admission and revises as needed depending on needs of the patient.
   
   
3. Accepts on-call as scheduled and responds as needed.
   
   
4. Takes responsibility for upgrading professional skills and knowledge.
   
   
5. Prepares and completes reports; participates in special projects.
   
   
6. Demonstrates clinical competency by completing BLS CPR assigned by Education and ACMA Compass training modules for new employees assigned by Director of Case Management.
   
   
7. Performs other duties as assigned.

The intent of this job description is to provide a representative summary of the major duties and responsibilities performed by incumbents of this job. Incumbents may be requested to perform tasks other than those specifically presented in this description.