Responsibilities
- Collaborate with supervisors and multidisciplinary teams to implement, review, and enhance care coordination models and workflows.
- Advocate for effective case management and care coordination practices to support programme and organisational objectives.
- Coordinate with operational and clinical stakeholders to improve patient care delivery and service integration.
- Assess patients’ medical, psychosocial, and functional needs in collaboration with the care team to support holistic care planning.
- Identify care gaps and engage patients and caregivers to support individualized care goals.
- Educate and guide patients on lifestyle modifications and self-management strategies for continued wellness in the community.
- Facilitate advance care planning discussions and ensure patient preferences are incorporated into care plans.
- Recommend appropriate referrals to transitional care and community support services based on patient needs.
- Monitor and follow up with patients to ensure smooth transitions across healthcare settings.
- Maintain accurate documentation and ensure compliance with established workflows and care processes.
- Participate in case reviews, knowledge-sharing sessions, and continuous learning initiatives.
- Review and triage referrals for transitional and community care services according to established criteria.
- Manage referral records and databases accurately and in a timely manner.
- Communicate and coordinate effectively with referral sources and care teams regarding referral outcomes.
- Maintain up-to-date knowledge of transitional care programmes and community support services.
- Build collaborative partnerships with internal and external healthcare and community service providers.
- Provide guidance and support to junior care coordination staff where required.
- Support community outreach and public health initiatives.
- Contribute to quality improvement projects, research activities, and educational programmes.
- Degree or equivalent professional qualification in Nursing, Social Work, Allied Health, or a related discipline.
- Minimum 5 years of experience within the healthcare industry.
- Experience in case management, care coordination, nursing, or related healthcare functions is preferred.
- Experience collaborating with clinicians, multidisciplinary teams, or developing healthcare programmes and projects is advantageous.
- Knowledge of specialised medical, surgical, rehabilitation, psychological, home care, or community care services is an added advantage.
- Strong interpersonal and stakeholder management skills with the ability to engage effectively across all levels.
- Strong organisational, analytical, and problem-solving abilities.
- Ability to work independently while demonstrating initiative and accountability.
- Adaptable and comfortable working in evolving and complex environments.
- Good verbal and written communication skills.
- Proficiency in local languages and dialects is an advantage for liaising with local languages-speaking and dialects-speaking patients, caregivers, and stakeholders.
- Proficient in Microsoft Office applications, including Word, Excel, and PowerPoint.
- Familiarity with healthcare or hospital information systems is an added advantage.
We regret that only shortlisted candidates will be notified. However, rest assured that all applications will be updated to our resume bank for future opportunities.
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EA Personnel Name: Ong Zong Kai
EA Personnel Reg. No.: R26163383
EA Licence No.: 07C5771