ABOUT THE LEGACY LIVING AND REHABILITATION CENTER

The Legacy Living and Rehabilitation Center, part of Campbell County Health’s comprehensive system of care facilities, is a long-term care facility offering both long-term care and short-term rehabilitation services in Gillette, Wyoming. Built with our residents and their families in mind, we are committed to providing dignified care and purposeful living every day.

To be responsive to our employee’s needs we offer:

• Generous PTO accrual (increases with tenure)
• Paid sick leave days
• Medical/Dental/Vision
• Health Savings Account, Flexible Spending Account, Dependent Care Savings Account
• 403(b) with employer match
• Early Childhood Center, discounted on-site childcare
• And more! Click here to learn more about our full benefits package

JOB SUMMARY        Working in conjunction with the Nursing Home Administrator, the Admission and Discharge Coordinator focuses on integrating care management, social services, discharge planning, utilization review and post-hospital services to ensure clinical efficacy and best outcomes for our residents. The Coordinator, works to ensure the provision of quality health care along the continuum of care, decrease fragmentation, enhance the resident’s quality of life, efficiently use resident care resources, maximize cost containment opportunities, and improve successful post-hospitalization transition care. The Admission and Discharge Coordinator ensures a safe transfer to a setting that meets the patient’s needs and coordinates necessary services to complete the transfer. The Admission and Discharge Coordinator guides the integrated team in the functions of care coordination, facilitation of referrals, education, discharge planning, utilization management, and advocacy.   ESSENTIAL FUNCTIONS   

• Completes assessment of resident and family in timely manner. Specific attention is paid to at risk and/or resource intense residents. Residents’ identified with complex psychosocial, financial or complex discharge issues may be referred to Social services.
• Assess resident/family adaptation to illness/disability and capacity to provide for residents care needs. Completes assessment of resident clinical course to provide ongoing residents care coordination. Verifies residents’ needs for appropriate level of care. Identifies obstacles to discharge.
• Collaborates with providers, therapists, social services, nurses and other disciplines involved with care of the resident to foster a coordinated approach to resident care. Communicates with provider regarding the medical plan of care, anticipated discharge, and consideration of alternative setting. Facilitates and impacts process issues to avoid delays in resident care. Intervenes with appropriate individual/departments regarding delays in service that may have an impact on quality of care and/or length of stay.
• Screens potential residents for admission utilizing consistent admission standards.
• Function as a liaison to internal and external agencies to maximize rehabilitation potential and therapy participation.
• Maintains clear and concise documentation in each resident record to reflect physical and functional limitations, psychosocial characteristics, educational needs of resident and family, family/social support systems, financial, economic, and discharged needs. Initiates referrals to disciplines as indicated.

• Documentation will reflect plan of care to address post-hospital care needs and evidence of resident/family involvement in planning.
• Assists resident and families with community resources. Promotes empowerment of resident in self-management of disease process.
• Utilization review of the resident stay is done in a timely manner and is documented as appropriate
• Clinical is provided to insurance agencies/payer in a timely manner. Coordination with the Billing Supervisor and MDS regarding Medicare and other payor sources qualification.
• Demonstrates commitment to work partners to help each other reach mutual goals and learn from each other. Demonstrates actions and behaviors that consistently promotes trust, respect, positive attitude and promotes team morale.
• Adheres to CCH policies and procedures.
• Aggregates data related to admissions and discharges and reports monthly to Quality committee.
• Promotes team approach to rehabilitation program.
• Provides service excellence to all customers in accordance with AIDET and Excellence Every Day.
• Conducts self in professional manner, using Standards of Behavior as outlined by CCH.
• Maintains professional relationships with other departments, external organizations, service providers, Providers, and families of residents.
• Must be free from governmental sanctions involving health care and/or financial practices.
• Complies with the hospitals Corporate Compliance Program including, but not limited to, the Code of Conduct, laws and regulations, and hospital policies and procedures.
• Performs other duties as assigned.
• Assists in home visits in preparation of reviewing residents for appropriate placement in LTC
• Participates in care conferences as needed to assist in discharge planning to optimize resident outcomes.

JOB QUALIFICATIONS

• Education
• Associate or Bachelor’s degree in: healthcare administration, nursing, social work, business administration, or human services related field preferred.

Experience

Minimum of 1 years in healthcare field preferred with exposure to admissions, discharges, care coordination. Clinical experience is preferred.

Certifications required

See Cardiopulmonary Resuscitation Certification Policy and Certifications/Education Requirements Policy.

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