Founded in 1973, Dignity Health - Methodist Hospital is a 158-bed, acute care, nonprofit hospital located in Sacramento, California. Serving over 80,000 patients annually, the hospital offers a full complement of services including a Level II NICU, heart care, cancer care, women’s health, and neurology. Additionally, Methodist Hospital of Sacramento has been recognized as an LGBTQ+ Healthcare Equality Leader by the Human Rights Campaign Foundation and is a Joint Commission-certified Primary Stroke Center.
As our RN Care Coordinator, you will help patients and their families navigate the healthcare continuum and coordinate individualized care plans so they can achieve optimal health outcomes and experience a seamless transition across care settings.
Every day, you will collaborate with interdisciplinary teams to assess patient needs, coordinate services, and develop comprehensive care plans. You will be expected to advocate for patients, facilitate transitions of care, monitor progress toward goals, and connect patients with appropriate community and healthcare resources.
To be successful in this role, you will demonstrate strong clinical judgment, exceptional communication and collaboration skills, and experience coordinating care across multiple disciplines and settings while maintaining a patient-centered approach.
Completes and documents a discharge planning assessment on those patients identified by the designated screening process, or upon request, and reassesses the patient as appropriate while updating the plan accordingly.
Facilitates the development of a multidisciplinary discharge plan, engaging other relevant health team members, the patient and/or patient representative, and post-acute care providers in accordance with the patient's clinical or psychosocial needs, choices, and available resources.
Collaborates with the healthcare team and post-acute service providers to ensure timely and smooth transitions to the most appropriate type and setting of post-acute services based upon patients' clinical needs.
Identifies risk for readmission and implements interventions to mitigate those risks for at least a 30-day period.
Responsible for patient education and advocacy.
Required:
Preferred:
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