Care Management Coordinator

Salary range: The salary range for this position is CAD $47.77 - $65.12 / hour Why Fraser Health?:
Fraser Health is responsible for the delivery of hospital and community-based health services from Burnaby to Fraser Canyon on the traditional, ancestral and unceded territories of the Coast Salish and Nlaka’pamux Nations, and is home to six Métis Chartered Communities.

Our team of 45,000 staff, medical staff and volunteers is dedicated to serving our patients, families and communities to deliver on our vision: Better health, best in health care. Learn more.

**Come work with us**

Joining our team offers you opportunities to work in a rapidly growing organization with health professionals who are excellent in their respective fields, career growth and advancement, a competitive compensation package (including four weeks of vacation to start, comprehensive health benefits, and pension plan), and the rewarding opportunity to make a difference every single day in health care.

Effective October 26, 2021 all staff for all positions across health care in British Columbia are required to be fully vaccinated against COVID-19 (have received a full series of a World Health Organization “WHO” approved vaccine against infection by SARS-COV-2, or a combination of approved WHO vaccines). Please note this applies to all postings, and there are no exceptions.

Fraser Health values diversity in the work force and strives to maintain an environment of Respect, Caring and Trust. Fraser Health’s hiring practices aspire to ensure all individuals are treated in an inclusive, equitable, and culturally safe manner.

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Connect with us on our Careers social channels where you’ll learn about exciting opportunities, get career tips from our recruiters, and meet some of your future team members You can also visit us on Indeed and Glassdoor.

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Detailed Overview:
In accordance with the British Columbia College of Nurses and Midwives (BCCNM) standards of practice as well as within a patient and family centered care model and the Mission and Values of Fraser Health, the Care Management Coordinator, in collaboration with the Patient Care Coordinator and the interprofessional team, facilitates patients' hospitalization from admission through discharge. Coordinates and collaborates with the interprofessional team to expedite effective, quality patient care and coordinates timely and sustainable discharge plans. Intervenes to address barriers and provides leadership as needed to achieve optimal outcomes including helping to expedite additional services as required. The Care Management Coordinator is accountable for the development and effectiveness of policies, procedures and standards to support effective care management and discharge planning. Evaluates progress towards desired outcomes to ensure plan of care and services provided are patient-focused, of high quality, efficient and effective.

**Responsibilities**:

- Coordinates care and discharge planning for patients; proactively collaborates with the Patient Care Coordinator, physician and interprofessional team to determine discharge goals. Works closely with the home health liaison team to determine available services and prioritize discharge planning activities based on patient level of need/risk. Leads interdisciplinary rounds by facilitating care planning with the health care team and other stakeholders. Focuses team members on developing medical/functional goals as well as discharge plans to ensure a safe, appropriate and timely discharge.
- Facilitates patient flow activities by identifying patients requiring specialized attention in order to move effectively through the system. Coordinates patient transfer to alternate level of care. Acts as a resource/advisor for referral to services relative to diagnoses and post-discharge care.
- Observes, monitors and evaluates assigned patient progress, symptoms and behavioral changes by reviewing patients' daily status, anticipating responses to care, and identifying problems or variances from the expected care plan; conducts comprehensive nursing assessments if required. Intervenes to facilitate resolution of problems and removal of barriers. Reorganizes priorities and collaborates with the physician and interprofessional team to revise care plans as required to ensure that the plan of care and services provided are patient-focused, high quality, efficient and effective; includes patient/family in evaluating progress towards their goals.
- Develops and recommends policies, procedures and standards to support effective care management and discharge planning. Consults and collaborates with physicians and other health care professionals/providers in the identification and resolution of a variety of patient care issues by methods such as coordinating multidisciplinary team conferences, utilizing established acute care standards, allowing for individual variances, and de