Care Coordinator

Overview*
The National University Cancer Institute, Singapore (NCIS) is a national specialist centre under the National University Health System (NUHS). It is the only public cancer centre in Singapore treating both paediatric and adult cancers in one facility. As an employer, NUHS has won #1 Public Healthcare employer for 4 years consecutively.
Join Us to be our Palliative Care Coordinator, where you'll be the guiding light for patients and families navigating complex healthcare journeys. You'll wear many hats - part navigator, part educator, part data wizard, and full-time compassionate human being. You stand to gain immense satisfaction from direct patient care delivery with key contributions to efficient and timely care coordination including diagnosis, treatment, rehabilitation, follow-up, survivorship, and end of life care.
Job Responsibilities*

A. Direct care
1. Care Navigation

Provide individualized assistance (informational and emotional support) to patients and their families to overcome healthcare system barriers, improve continuity of care and quality of Palliative care.

Identify and navigate needy (high-risk) patients through the journey to ensure that they do not fall through the gaps and have access to the resources they need.

Follow-up with patients through phone, where necessary. This will enable patients, easier access to the medical team hence reducing unnecessary re-attendances to Emergency Department and potential admissions.

To follow up with patients who defaulted clinic first visit and reviews and ensure continuity of care is established.

Assist patients and their families to transit across different services and location.

Communicate effectively with health care professionals in providing smooth transitions.

Perform assessment to identify patients’ physical, psychosocial and spiritual needs, and barriers in accessing to health care system. Initiate interventions to address the identified barriers, and in meeting the physical, psychosocial and spiritual needs.

Perform patient navigation outcomes evaluation.

2. Care coordination

Ensure compliance to palliative care pathways and to streamline care for inpatients and outpatients.

Ensure smooth transition of care and right-siting of patients, including working with community partners such as Palliative Home Care and inpatient hospice and Palliative Care service (IHPCS).

Ensure timely and appropriate referral to specialist, allied health and support services

Assist in coordination of care between services (medical, surgical or allied), and between settings (inpatient, outpatient, home, and community).

Liaise with internal stake holders including Medical Oncologists, Surgical Oncologists, Radiation Oncologists, Radiologists and other specialists, involved in the patient’s care.

Perform outcomes evaluation of care pathways.

B. Education

1. Patient education

Patient and family education pertaining to the palliative care approach, symptom management and available resources

Triage patients to subspecialty care
2. Staff resource

Advise and guide clinic staff regarding internal referral, community home care & day care referral, and estimated cost for financial counselling.

Support multidisciplinary team members pertaining to patient care matters
C. Data management

Compile data and build database with annual audits

Assist in simple data analytics and participate in quality improvement projects that aim to improve coordination of care and optimize outcomes for individual and services.

Work with VDO teams to measure outcomes
D. Research

Coordinate palliative care research and QI projects.

Liaise with research staff working on palliative care studies.

Ensure compliance with research ethics and data governance policies.
E. Quality Improvement and National Initiatives

Collaborate with Singapore Hospice Council (SHC) on national initiatives:
National Guidelines for Palliative Care

National Minimum Data Set

National Caregiver Survey

National Palliative Care Benchmarking

Participate in SHC and MOH-led workgroups or pilot programmes.
F. Leadership and professional development

Facilitate quality improvement activities.

Assist in expanding palliative care coordination and navigation services

Participate and facilitate strategic planning for palliative care

Any other projects/ tasks as assigned by dept.

Requirements*

Bachelor degree in Health Sciences, preferably in Degree in Nursing or Allied Health relevant to the job.

Possess good interpersonal and communication skills with the ability to work independently and as part of a team