CaroMont Health
Gastonia, NC, USA
Job Summary:# Responsible for acute care sites of service to assess, plan, facilitate, and integrate coordinated care for patients from preadmission/ED through discharge with a plan of care that supports post discharge care needs across the continuum. Addresses barriers, social determinants of health, high utilizers of sites of service, supports and integrates psychosocial and legal components that impact the patient and the plan of care. Coordination of post discharge services including but not limited to when applicable per patient needs: placement, durable medical equipment, home health, personal care services, and other complex care support needs. Consults with the multi-disciplinary teams, committees, Service Lines, Providers, and the patient/family. Compliant with state, federal, hospital and TJC guidelines. Follow the standard work for the Case Management department which includes but not limited to discharge planning starts on admission, timely documentation, education on...
Administration & Operations
Assistant & Support
Nursing
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