Care Consultant, Care Transition

4 days ago


Orchard Central Community Development Council, Singapore Agency for Integrated Care (Singapore) Full time $80,000 - $120,000 per year

Job description:

Being part of the Care Transition team, the Care Consultant plays a vital role in assisting clients and caregivers in navigating the complexities of health and social care systems.

The job scope includes:

  • Review and analyse clients' records and aplication history to understand their care related history and status.
  • Conducts interviews with clients to gather information on their medical, functional, cognitive, psychological, social, environmental, and financial needs in various settings, including hospitals, clients' homes, and other pertinent locations.
  • Perform relevant assessments e.g., interRAI, Residential Assessment Form (RAF), Functional Assessment Report (FAR), Modified Barthel Index (MBI), Abbreviated Mental Test (AMT), Clinical Frailty Scale (CFS) and other relevant assessment tools.
  • Leverage on the assessment done by other health professionals such as Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS) and other relevant assessment tools, to gather essential information on clients.
  • Apply clinical reasoning and critical thinking to interpret assessment findings and identify issues, including red flags that require intervention.
  • Collaborate with multidisciplinary teams, including clinicians, social workers, and caregivers, to discuss issues and formulate or refine care plans for optimal outcomes.
  • Implement interventions to manage identified issues and red flags, ensuring that clients receive appropriate care and support.
  • Share, promote and administer MOH and other agency initiatives, campaigns, programmes, services, schemes and grants and facilitate the application.
  • Advocate for clients' and caregivers' preferences and address their expectations while ensuring compliance with clinical and operational guidelines.
  • Educate clients and caregivers on managing clients' conditions to enhance their ability to engage in self-care and cope effectively within the community.
  • Serve as a resource and point of contact for clients and caregivers, building and maintaining strong relationships.
  • Refer clients to appropriate healthcare providers and community care partners based on their needs.
  • Assist and contribute as a subject matter expert for the continuous improvement of systems, processes, and services.

Job Requirements

  • Professional qualification in Nursing, Social Work, Counselling, Allied Health disciplines or a similar field along with relevant industry experience.
  • At least 3 years of experience in related field in acute and/or community healthcare settings in Singapore.
  • Knowledge in geriatrics, care coordination, community services and customer services will be an added advantage.
  • Proficient in Microsoft Office (Word, Excel, Powerpoint).
  • Pro-active work attitude with good interpersonal, communication and organizational skills.
  • Exhibit strong critical thinking and problem solving skills while setting priorities.
  • Good collaborator who is able to work effectively and harmoniously with internal and external stakeholders.
  • Keep abreast on the various clinical assessment tools, community services and schemes.
  • Able to work independently, multitask effectively under pressure and highly adaptable to changes.
  • Able to comply to process/manuals, advisories, guidelines, policies, legislations/Acts relevant to healthcare and the area of work.
  • Candidate may be required to carry out the above-mentioned duties in AIC HQ or hospital setting.


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