Responsible for the coordination, integration and facilitation of all care and services for the patient by all members of the health care team. Performs admission assessment, screening for appropriateness, and monitoring of plan of care to address physical and psychosocial needs, and provides problem solving assistance. Coordinates services, discharge planning, referrals to appropriate community agencies and assists with Advance Directives when appropriate. Promotes communication and collaboration among all members of the health care team to ensure that specific patient outcomes are achieved and variances from accepted parameters are evaluated and addressed as needed. Additionally this position serves as a mentor and resource providing support and assistance to the care coordinators as related to care coordination role, responsibility, and professional development.
Care Coordination/Assessment/Planning - 40% annually
Leadership - 40% annually
Relationship Building - 10% annually
Basic UPH Performance Criteria - 10% annually