Serve as a resident/family advocate to facilitate positive outcomes for the resident, which are achieved through collaboration with the resident/family as well as healthcare providers participating in the resident’s plan of care. Attend interdisciplinary team meetings, including the weekly resident at-risk meeting. Review the resident's records and gather clinical information from the current care delivery team, and the resident/family, to understand progress toward goals, discharge, and anticipated length of stay. Assist the interdisciplinary team with the health eligibility screening process for independent living. Introduces an accurate and thorough report to team members prior to move-in or admission of the resident to ensure the continuity of optimal resident care. Assist residents or families with resources to carry out physician orders for medications, care, treatment, and follow-up appointments. Assist residents upon request with coordination of care as required, including the need for home health, hospice, therapy and DME services. Encourage resident/family engagement and involvement in care by providing education regarding the resident's medical condition, disease and symptom management, and referral sources and community resource options. LPN/LVN or RN required. Two years of recent experience working in senior living, home health, or post-acute care environments. Previous care management experience is preferred.
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