Required Skills: Care coordination, Collaborative care, Conduct initial evaluation, Coordinates with internal and external team members, Develop plan of care to meet patient/caregiver needs, Discharge Summary, Documentation according to plan of care, Documentation of care delivery, plan, goals, etc, Documentation of patient/caregiver teaching/learning, Documentation reflects understanding of coverage criteria, Documents patient response, Documents pertinent information to facilitate care coordination, Educates patient/caregiver to facilitate discharge, Establish and revise goals, Medicaid, Medicare, Participates in care conference activities, Provide / reinforce individualized patient/caregiver education, Plan of Care. Travel, per diem, permanent — we have the reach and access to get you the jobs you want, and the expertise to help you realize your long-term goals.