Job Summary
To access care needs, provide care coordination, monitor the clinical and well-being of patients and their caregivers to ensure coping of the patients and a smooth transition of care to the community.
Job Responsibilities:
- Assess patient's medical, physical, cognitive, economic and social needs as well as their available support systems.
- Provide ongoing support and education to the caregivers, patients and families.
- Conduct post discharge follow-up via phone calls and/or home visits to ensure adequate and ongoing support and education to the patients, caregivers and families.
- Work in partnership with care professionals in the social and healthcare sectors to enhance patient's well-being across the continuum.
- Collaboration with patients, caregivers and the families to facilitate shared decision making.
- Participate in activities that contribute towards the improvement of the quality of patient care and support care integration activities.
Job Requirements:
- Healthcare or social services qualification such as nursing or allied health/social services-related experiences.
- Diploma in related industry such as healthcare, social or community services sectors. Degree preferred but not essential.
- At least 5 years of working experience in healthcare, social or community services sectors.
- Case management experience is an advantage.
- Keen to work in the community setting.
Pre-requisites
- Passionate about elderly care, including providing counselling and supporting families with social matters such as discharge care planning.
- Engaging with patients, family members, the public and healthcare partners.
- Skilled in collaborating with healthcare partners within the hospital's multi-disciplinary team and outside the hospital.
- Demonstrates integrity, leadership, resourcefulness, resilience, adaptability and strong interpersonal and communication skills.
- Able to work independently and also a strong team player.
