Develops implements, coordinates, monitors and evaluates preliminary and final discharge plans with the interdisciplinary team, patient and family.
June 11, 2022
Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently.
December 05, 2022
Performs outpatient and clinic care coordination and monitors care as patients transition between outpatient and inpatient services where appropriate.
January 05, 2023
Communicates effectively with facility staff and hospitalist to gather clinical information through verbal and written communications, and provides timely and accurate responses to request information or provide authorization decisions.
March 03, 2023
Provide nursing services, treatments, diagnostic and preventive procedures requiring the skills of a registered nurse according to physician orders and the in-patient facility protocols.
March 07, 2023
Participates and facilitates care progression in daily multidisciplinary rounds and addresses target length of stay with health care providers to achieve complete delivery of services within prescribed timeframe.
March 14, 2023
Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement or home health follow-up.
March 29, 2023
Monitors and ensures compliance with all regulatory requirements, organizational standards, and policies and procedures related to area of responsibility.
April 02, 2023
Completes initial screen of all patients on admission (not to exceed within 24 hours of admission) utilizing specific trigger criteria to identify needs related to care coordination and/or discharge planning.
April 06, 2023
Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families.
May 01, 2023