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Care Coord Pop Health- Post Acute AdventHealth PHSO Resources

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. Its 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 8:00am to 5:00pm

**Location:** Remote

The role you'll contribute:

The Post-acute care coordinator's primary responsibility is to oversee post-acute care utilization for identified populations. The Post-acute care coordinator will monitor length of stay while a beneficiary is in a skilled nursing facility and evaluate for appropriate discharge planning. When needed, the Post-acute care coordinator will advise on possible alternative discharge plans for complicated cases. Developing and maintaining collaborative relationships with post-acute care facilities' staff will be key in monitoring length of stay during skilled nursing facility stay and assisting in discharge planning. The Post-acute care coordinator will participate in facility clinical rounds weekly or more often as necessary. Access to and use of facility electronic health records, when available, will enable daily monitoring of beneficiary activity and progress. Communication with beneficiary and/or family may be necessary to facilitate discharge planning and collaboration with primary care practices. Care coordination will include post-discharge follow-up and transitions of care telephonic outreach to maintain continuity of care.

The value you'll bring to the team:

+ Works with all clinical teams as a resource for the health management of identified patients.

+ Reviews charts during skilled nursing facility stays, including facility EHR and primary provider EHR.

+ Coordinates care post-discharge from facilities, including follow-up appointments and confirmation of home health agency communication.

+ Attends facility clinical rounds weekly via telephone.

+ Communicates with provider practices for updates and facilitates interdisciplinary conferences.

+ Conducts outreach to patients during their stay to advocate for safe and expedited discharge planning.

The expertise and experience you'll need to succeed:

Minimum qualifications:

+ High School Grad or equivalent

+ 1 year skilled nursing facility, acute care facility, or post-acute care management

+ Licensed Practical Nurse (LPN) - State Licensure

Preferred qualifications:

+ Case Management

+ Registered Nurse State Licensure and/or Compact State Licensure In Florida

+ Case Management Specialist (CMS)

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

**Category:** Population Health

**Organization:** AdventHealth PHSO Resources

**Schedule:** Full-time

**Shift:** 1 - Day

**Req ID:** 25040991

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability/handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.