Care Coordination

The function of Care Coordination is to:
  • Register patients in a timely manner while ensuring information entered is accurate.
  • Assign patients from various points of entry by using appropriate aggregation and level of care.
  • Assess and identify psychosocial, medical and discharge planning needs of patients and the health care services to meet those identified needs.
  • Identify appropriate alternate levels-of-care settings.
  • Provide ongoing communication and collaboration with members of the healthcare team.
  • Practice utilization management (appropriateness of admission and continued stay).
  • Practice clinical resource management (expedition of tests, procedures and referrals).

Social workers provide the following services as appropriate to the setting and individual patient needs:

  • Psychosocial assessment
  • Supportive counseling for patients, families and group modalities
  • Discharge planning for ICU’s and complex psychosocial discharge needs
  • Advocacy
  • Psycho-education for patients and families
  • Crisis intervention
  • Bereavement counseling
  • Adoption, foster care, guardianship
  • Prevention of domestic violence and abuse

Last Update

May 21, 2010
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