REPORTS TO: Director of Case Management or Vice President of Nursing
To monitor program and coordinate services related to clients residing in the Skilled Nursing Facility. To facilitate the development of an appropriate and integrated treatment plan and coordinate discharge planning services.
Work independently with moderate degrees of direction from the Director of Nursing to review services and resources for clients. Coordinate the admission through discharge process with a broad range of collateral participants including family, educational/medical/nursing/rehabilitative team members, school district personnel, and the area agency/community support system.
Bachelors Degree in Social Work/or a licensed registered nurse, with at least five years of relevant work experience may be considered. Prior experience in client/case manager communication and rapport. Some prior experience in a multi-disciplinary setting that includes medical services for the multi-handicapped, client assessment and coordination of admission to facility, and discharge planning coordination with community providers.
- Regularly required to sit; use hands to type or write; reach with arms or hands; talk & hear.
- Frequently required to stand, walk, stoop, kneel or climb stairs. Lift or move objects weighing up to 25 pounds.
- Ability to drive vehicle and transport clients.
Forty hours per week. Generally Monday through Friday. Flexible schedule to respond to programmatic/student needs as approved by Director of Nursing.
- Visit homes and hospitals to access clients for timely admission to Hayden unit. Gather admitting information for all departments including finance. Coordinate transfer process.
- Act as liaison between team members and families, and keep information flowing between all parties.
- Advocate for individual clients, and be proactive in awareness of their rights and the services available to them.
- Ensure that an updated and accurate social history is completed upon admission and annually.
- Ensure completion of at least monthly summary notes. Arrange for appropriate and timely discharge of clients with adequate community planning that addresses clients wants and needs.
- Be responsible for correspondence relating to students. Ensure that parents/guardians and involved agencies are informed of staff conferences within adequate time for them to plan to attend, and encourage their participation as team members. Represent concerns of families and agencies to the team.
- Develop an in-depth knowledge of the clients, their status in treatment and projected therapeutic outcomes.
- Develop a long-term network with family, agency, community and engages families in the education/rehabilitation process.
- Under the supervision of the Director of Nursing and following accepted methods or practices and CMRC guidelines, ensure that Individual Education Plan (IEP) is composed and completed and that review dates are scheduled.
- Work effectively as an interdepartmental/interdisciplinary communication facilitator.
- Coordinate respite program. Plan all admissions, conduct visits/tours, coordinate stays and discharges from program.
- Develop master calendar for bed use.
- Enter statistical information into computer system for census and financial status.
- Conduct annual satisfaction program survey to clients and families.
- Prioritize and effectively manage and organize time.
- Ensure timely documentation of care needs to families and staff.
- Perform such other duties as may be assigned.
- Carry out all responsibilities in a professional, efficient, and timely manner.
- Adhere to the policies and procedures established by Crotched Mountain Foundation and Crotched Mountain Rehabilitation Center and other regulatory agencies.
- Respond to all community, staff and client needs and concerns with respect and tact.
- Uphold the mission of Crotched Mountain as put forth in the Workplace Culture and Values Statement.