PT Nurse Care Coordinator

Responsible for providing care coordination for individuals in the community for the Diocesan VITALity Catholic Healthcare Services. Establish effective and respectful relationships with patients, families, professionals, payers and other relevant parties. Accurately conduct face to face assessments (in the home, community or medical setting) on the person’s physical, social, psychological, financial status, family caregiver support, as appropriate, to identify the person’s strengths and limitations related to the identified concern. Use teaching skills to ensure understanding by patient/ family regarding available services and self-management. Work with patients and families to set appropriate goals and support the patient and family in reaching the goals using the skills of coaching and consultation. Develop an individualized care/service plan with the patient (and family as appropriate) that identifies priorities and desired outcomes, strategies and resources needed to achieve them. Monitor and adjust the plan as needed in collaboration with members of the individual’s health care team. Refer and facilitate access to services and directly access services if indicated. Monitor delivery of services and act as an advocate. Consider cost of services and work within program or patients budget to maintain quality of care/services. Evaluate individual outcomes of Care Coordination participants. Acknowledges patient’s rights on confidentiality issues, maintains confidentiality and follows HIPAA guidelines and regulations. Continues to educate self on providing quality care, professional, personal and spiritual growth. This position is 20 hours per week based upon employee availability and staffing needs. Qualifications and Educational Requirements Registered Nurse (RN) or MSW Social Work. Current license in New Jersey. CPR Certification. Minimum of 3 years of experience in health care, preferably community setting, home care, care coordination, discharge planning or case management. Highly organized and ability to work autonomously. Demonstrated skills in assessment, leadership, communication, counseling/consultation, problem solving and teaching. Core values consistent with patient and care giver center approach to care. Language Skills Bilingual preferred (English/Spanish) Excellent communication skills (written, verbal, non-verbal and technical) required. Competencies This position requires a person who is dedicated to improving the health and safety of seniors and disabled individuals through consultation and coordination of care. The person must be able to work independently in the community while collaborating with various community partners to access to health care and social services for the individuals we serve. The person will display a professional appearance and demeanor at all times. Collaboration and team work are key competencies for this position. In addition, the following competencies must be present: Problem solving, Sensitivity, Accountability, Ability to document effectively, Team work, Interpersonal skills, Ethics, Initiative, Dependability, Interpersonal skills, good judgement, Initiative and Diversity. The hourly range is $39.78-$42.36 for an RN. #J-18808-Ljbffr