Embedded Care Coordinator

The Embedded Care Coordinator at Novum Health works within a healthcare setting to provide comprehensive care coordination services to patients, ensuring their healthcare needs are effectively managed and coordinated. This role plays a vital part in enhancing patient outcomes, promoting continuity of care, and optimizing healthcare resources.

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Tasks Include (But not limited to)

• Coordinates the discharge planning and social service program, identifies patients needing psychiatric/mental health services after discharge
• Ensures smooth transition and comprehensive discharge plans for their patient and their family.
• Monitors clinical information to support the psychosocial assessment, treatment, education and continuity among healthcare providers and to enhance and improve individual and organizational performance in patient care.
• Conducts needs assessments consisting of social determinants of health.
• Plans and implements care in collaboration with the multidisciplinary team.
• Coordinates with patient the activities to meet patient’s goals
• Collaborates with interdisciplinary team to address need to move patient to a lower level of care, add/change/delete ancillary service, discharge a patient, change medication/treatment to a less expensive alternative, or provide education when appropriate
• Documentation of all interventions within the code and services provided.
• Exceptional leadership and team management skills, with the ability to motivate and engage a diverse team of healthcare professionals.
• Discharge planning psychiatric and social determinants of health related
• Strategic thinking and problemsolving abilities to drive operational efficiency and quality improvement.
• Commitment to patientcentered care and continuous quality improvement.
• Ability to build and maintain relationships with community organizations and stakeholders.
• Additional duties as assigned
• This position may be required to drive between different hospitals in the greater Las Vegas Area. As such, access to reliable transportation is required which can safely get the employee from one hospital to another in under an hour.

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Qualifications

Experience and Education

• Minimum of 1 year of experience in healthcare, care coordination, or a related field, preferably in a clinical or community healthcare setting and discharge planning.
• Experience in working with diverse patient populations and addressing complex healthcare needs.

Education

• Bachelor's degree in nursing, social work, public health, or a related field (or equivalent combination of education and experience)

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Skills

• Strong knowledge of healthcare systems, medical terminology, and care coordination principles.
• Excellent interpersonal and communication skills to establish rapport with patients, families, and healthcare professionals.
• Ability to assess patients' needs, develop care plans, and coordinate healthcare services accordingly.
• Proficiency in using healthcare software and technology for documentation and care coordination purposes.
• Strong organizational and time management skills to prioritize and manage multiple patient cases effectively.
• Ability to work collaboratively in interdisciplinary teams and build relationships with community resources and healthcare providers.
• Critical thinking and problemsolving abilities to address complex patient situations and navigate healthcare challenges. Cultural sensitivity and awareness to provide patientcentered care in diverse communities.
• Strong advocacy skills to ensure patients' needs are met and their rights are respected.
• Ability to work independently, make informed decisions, and adapt to changing healthcare environments.
• Knowledge of healthcare policies, regulations, and compliance requirements related to care coordination and patient privacy.