Transition Care Case Manager
Core
Provide high-quality, evidence-based case management and care coordination for older people transitioning from acute/subacute hospital care to residential aged care or independent living.
Role type
Transition Care Case Manager (Registered Nurse or Grade 2 Allied Health Professional)
Builds
Short-term support and active management services for older people at the interface of acute/subacute and residential aged care sectors.
Domain
Healthcare / Aged Care / Transition Care
Deliverable
physical/clinical work
Required skills
Case management principles and practice frameworks, holistic health assessments, care coordination, discharge planning, multidisciplinary team collaboration, community support service establishment, residential care option identification
Preferred skills
Aged care or subacute setting experience, postgraduate qualifications, ability to supervise students or staff
Technologies
None stated
Responsibilities
Conduct comprehensive holistic health assessments, coordinate health and social care needs, monitor achievement of client goals, facilitate intervention from other health care professionals, ensure appropriate linkages with hospital and community services, establish ongoing community support services, identify residential care options
Seniority
Mid-level, hands-on IC