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About the Role
Lead and coordinate comprehensive discharge planning for patients with complex clinical, psychosocial, and care needs, ensuring safe, timely, and person-centred transitions from hospital to community care. Provide advanced clinical assessment, expert consultation, and evidence-based decision-making to support patients, families, and multidisciplinary teams throughout the patient journey. Identify barriers to discharge early, implement proactive strategies to mitigate risk, and coordinate interventions that reduce delays, avoidable readmissions, and prolonged hospital stays. Partner with medical, nursing, allied health, patient flow, and external service providers to develop and implement integrated care plans that support continuity of care beyond discharge. Coordinate referrals to internal and external health, aged care, disability, and community support services, ensuring patients receive appropriate ongoing care and support. Provide clinical leadership, education, mentoring, and specialist guidance to multidisciplinary teams, promoting best practice in complex discharge planning, patient flow, and care coordination. Drive quality improvement initiatives, innovative models of care, and service development activities that enhance patient outcomes, improve organisational flow, and strengthen integrated care delivery.
Responsibilities
- Lead and coordinate comprehensive discharge planning for patients with complex clinical, psychosocial, and care needs.
- Ensure safe, timely, and person-centred transitions from hospital to community care.
- Provide advanced clinical assessment, expert consultation, and evidence-based decision-making.
- Support patients, families, and multidisciplinary teams throughout the patient journey.
- Identify barriers to discharge early and implement proactive strategies to mitigate risk.
- Coordinate interventions that reduce delays, avoidable readmissions, and prolonged hospital stays.
- Partner with medical, nursing, allied health, patient flow, and external service providers.
- Develop and implement integrated care plans that support continuity of care beyond discharge.
- Coordinate referrals to internal and external health, aged care, disability, and community support services.
- Provide clinical leadership, education, mentoring, and specialist guidance to multidisciplinary teams.
- Promote best practice in complex discharge planning, patient flow, and care coordination.
- Drive quality improvement initiatives, innovative models of care, and service development activities.
- Enhance patient outcomes, improve organisational flow, and strengthen integrated care delivery.
Requirements
- Demonstrated advanced experience in complex discharge planning, care coordination, patient flow, and integrated models of care within acute and/or sub-acute healthcare settings.
- Proven ability to work collaboratively across multidisciplinary teams and with external health, community, disability, and aged care providers.
- Facilitate safe, timely, and person-centred transitions of care.
- Highly developed leadership, critical thinking, analytical, and problem-solving skills.
- Ability to manage competing priorities, influence change, and contribute to service development and quality improvement initiatives.
- Experience in patient flow management, discharge planning, service redesign, and the application of evidence-based practice and data to improve patient and organisational outcomes.
- Exceptional communication, stakeholder engagement, and relationship-building skills.
- Ability to effectively negotiate and collaborate with patients, carers, clinicians, and external partners.
- Demonstrated commitment to clinical governance, professional development, quality improvement, research, and evidence-based practice.
- Ability to provide leadership, education, mentoring, and support to multidisciplinary teams.
- Ability to work autonomously, exercising a high level of professional judgement, clinical reasoning, and decision-making in complex care coordination environments.
- Proficiency in Microsoft Office applications and electronic patient management, referral, and documentation systems.
- Current registration as a Registered Nurse (Division 1) with AHPRA (for CNS2 applicants).
- Relevant postgraduate qualification and a minimum of three years' experience in the relevant clinical specialty (for CNS2 applicants).
- Degree qualification in a recognised Allied Health profession (for AHP4 applicants).
- Current registration with the relevant professional governing body (where applicable) (for AHP4 applicants).
- Must be an Australian or New Zealand citizen or have an Australia visa that grants the necessary work rights.
Skills
- Complex discharge planning
- Care coordination
- Patient flow management
- Integrated models of care
- Multidisciplinary team collaboration
- Stakeholder engagement
- Leadership
- Critical thinking
- Analytical skills
- Problem-solving
- Service development
- Quality improvement
- Communication
- Negotiation
- Collaboration
- Clinical governance
- Professional development
- Research
- Evidence-based practice
- Mentoring
- Clinical judgement
- Clinical reasoning
- Microsoft Office proficiency
- Electronic patient management systems
- Referral systems
- Documentation systems
Location
- Patient Flow Unit, St Vincent’s Public Hospital, Sydney
Work Type
- Permanent
- Full time
Experience Level
- Advanced experience in complex discharge planning, care coordination, patient flow, and integrated models of care
- Minimum of three years' experience in the relevant clinical specialty (for CNS2 applicants)
Education Level
- Relevant postgraduate qualification (for CNS2 applicants)
- Degree qualification in a recognised Allied Health profession (for AHP4 applicants)
Salary/Compensations
- $128,301.89 - $132,523.13 (CNS2)
- $131,585 - $134,775 (AHP4) + super
Benefits
- Not-for-profit salary packaging
- Study leave
- Curran Foundation scholarships
- Fitness Passport
- Discounted private health insurance
- Cultural recognitions and celebrations
- Smooth transfer of qualifying service and leave entitlements from NSW Health
About the Company
- St Vincent’s Hospital Sydney is a premier and iconic inner-city public hospital serving the entire population with world-class care.
- Founded by the Sisters of Charity, the hospital continues their legacy of compassionate service.
- Features cutting-edge programs and surgery infrastructure, fostering clinical excellence and professional growth.
- Located in Darlinghurst, with convenient access to public transport.
Equal Opportunity
- We celebrate diversity & inclusion and are committed to equal employment opportunity for everyone.
- We encourage Aboriginal and Torres Strait Islander peoples to apply and join us in delivering care that heals body, mind, spirit and community.
- St Vincent's acknowledges the importance of creating a work environment that is welcoming, safe, equitable and inclusive for Aboriginal and/or Torres Strait Islander Employees.