Care Coordination Discharge Coordinator - LPN
Optum in the tri-state region (formerly CareMount Medical, ProHEALTH New York and Riverside Medical Group) offers an interconnected network that enables us to work collaboratively to better coordinate care among our doctors and care teams. Together, we offer you and your family access to more than 2,100 providers, representing 70 specialties, working in 360 medical practices and more than 55 urgent care locations across New York, New Jersey, and Southern Connecticut. For more information, visit www.optum.com/tri.
ProHealth is one of the largest private multi-specialty medical practices in the Northeast and has been serving the health needs of Long Island and the Greater New York Metropolitan area since 1997. With over 900 providers in 300 locations, our goal is to provide quality health care to ensure that our patients get the right care at the right time.
At Optum, we are transforming healthcare nationally while providing physician-led care locally. Work with the largest care delivery organization in the world and start doing your life's best work.(sm)
CareMount Medical, P.C. is the largest independent multispecialty medical group in New York State, providing comprehensive medical care of the highest quality to over 640,000 patients in more than 45 locations throughout Westchester, Putnam, Dutchess, Columbia, and Ulster counties and New York City. Founded in 1946 as Mount Kisco Medical Group, CareMount has grown to over 600 physicians and advanced practice professionals representing more than 40 different medical specialties. CareMount is affiliated with world-class organizations including Massachusetts General Hospital, Mount Sinai Health System, and Memorial Sloan Kettering Cancer Center. CareMount offers on-site laboratory and radiology services, endoscopy and infusion suites, and operates eight urgent-care centers. Our physicians are frequently recognized as best doctors in respected publications and have been featured in lists including New York Magazine’s “Best Doctors,” Westchester and Hudson Valley Magazine’s “Top Doctors” as well as in Castle Connolly Medical’s “Top Doctors.” For additional information about CareMount Medical and its specialties, please visit: www.caremountmedical.com.
The group has always maintained a firm commitment to each of our patients...to provide high quality medical and surgical care in a warm, friendly setting, and in a caring manner. Each and every member of our professional and support staff is dedicated to this ideal - physicians, nurses, technicians and support personnel.
Position Overview: The Care Coordination Program at CAREMOUNT MEDICAL enables patients to be treated in an environment combining an expert medical team with individual attention and compassionate care. The Care Coordinator empowers patients to actively participate in improving their own healthcare through personalized care that targets each patient’s specific healthcare issues and needs. The Care Coordination Discharge Coordinator Nurse role is focused on reduction in Hospital readmission rates and use of the emergency department, based on determined ambulatory sensitive conditions. The Discharge Coordinator Nurse, in partnership with our Embedded Care Coordination RNs, performs essential, proactive, patient centered care to patients and their families during their acute care episode from various inpatient settings (ie. hospital, SNF, Rehab, ER) to ensure patients and their families understand the discharge care plan and work to facilitate appropriate follow up, both long and short term, with the goal of reduction in health care cost and utilization. The Care Coordination Discharge Coordinator Nurse is an integral part of CAREMOUNT MEDICAL care team and our approach to delivery of patient-centered, compassionate medical care, complementing the necessary professional services to patients.
- The Discharge Care Coordination Nurse is an integral member of the direct delivery care team, and serves as a gateway to information and support.
- The Discharge Care Coordination Nurse (LPN) performs daily communication with the acute care team, the Embedded Care Coordination RN, the PCP office care team, the patient and caregivers to ensure optimal communication and care, both during and after the acute care episode. The patient communication goal is to facilitate understanding of the hospitalization, the discharge care plan and assess patient literacy of same.
- The Discharge Care Coordination Nurse utilizes tools and documents that support a guided care process, collaborating with patients/families/Physicians and other members of the care team toward an effective plan of care during the hospitalization, including:
- Assess patient and family’s unmet health and social needs
- Provide effective communications to improve health literacy
- Develop a care plan based on mutual goals with patient, family and provider’s emergency plan, medical summary and ongoing action plan, as appropriate. Monitor patient’s adherence to plan of care and progress toward goals in timely fashion, facilitate changes as needed
- Facilitate patient access to appropriate medical and specialty providers as well as other care coordination team support specialists
- Ensure effective tracking of test results, medication management and adherence to follow-up appointments
- Facilitate communication between specialists and Primary Care Physician post-discharge for development of cohesive care plan, communicating action items to all responsible parties and following up to completion of same
- Attend and actively participate in care coordinator related training and meeting activities
- Perform regular visits to provide patient and family support and education
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
- Licensed Practical Nurse (LPN) in New York State
- Experience in caring for chronic disease patients
- Experience with navigation of local medical and social support systems
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation
- 3+ years of experience in clinical or community health settings
- Experience with Electronic Medical Records and Microsoft Excel
- Care Coordination, case management or Home Health experience
Knowledge, Skills and Abilities:
- Knowledge of community health services and willingness to develop and foster relationships with community resources of direct value to CareMount Medical patients and care team
- Solid organizational skills and demonstrated the ability to maintain accurate notes and records
- Solid interpersonal skills and an understanding and commitment to delivery of patient centered medical care with a team-based approach
- Ability to work independently, exercise creativity, is attentive to detail
- Ability to manage multiple and simultaneous responsibilities and to priorities scheduling of work autonomously
CareMount Medical, ProHEALTH Care Associates, and Riverside Medical Group (the “Practices”) are all physician owned and led practices having complete authority for all medical decision-making and patient care through their physicians and other licensed professionals. Optum, through its management organizations (“Optum”) provides non-clinical administrative services to support the Practices and their physicians. Neither Optum nor its management companies employ, engages, or supervises physicians or other licensed professionals, or determines or sets the methods, standards, or conduct of the practice of medicine or health care provided by the Practices or by any of their licensed professionals. “Part of Optum” reflects that the Practices are part of Optum’s effort to support forward-thinking physician practices in helping their patients live healthier lives.
All qualified applicants will receive consideration for employment without regard to race, ethnicity, color, religion, sex, gender identity, sexual orientation, national origin, disability, or protected veteran status. CareMount is an EO employer - M/F/Veteran/Disability
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
Careers with Optum. Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.
California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $18.80 to $36.78. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.