Complex Discharge Planner

Centene Corporation•Remote-PA, PA

3d•$27 - $49•Remote

About The Position

Develops, assesses, and coordinates complex discharge plans for high-risk members based on needs assessments. Supports a smooth transition from acute care to the next level of care and educates members and their families or caregivers about discharge plans to promote appropriate, high-quality transitional care. This is a remote, work-from-home Utilization Management role supporting Marketplace/Ambetter and Medicaid members in multiple states. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., based on the employee’s time zone. The hiring leader prefers an RN with a compact nursing license and experience in LTAC, inpatient rehabilitation, or a skilled nursing facility. The role requires graduation from an accredited school of nursing or a bachelor’s degree in nursing, along with 2–4 years of related experience and at least 2 years of acute care experience. An LPN or RN state license is required; RN compact-state licensure is also accepted. Clinical knowledge of discharge planning competencies, Medicare and Medicaid regulations, and utilization management processes is preferred.

Requirements

Graduate from an accredited school of nursing or a bachelor’s degree in nursing.
2–4 years of related experience.
At least 2 years of acute care experience.
LPN state licensure or RN state licensure; RN compact-state licensure is accepted.
Work Monday through Friday, 8:00 a.m. to 5:00 p.m., based on the employee’s time zone.

Nice To Haves

RN with a compact nursing license is preferred.
Experience in LTAC, inpatient rehabilitation, or a skilled nursing facility is sought by the hiring leader.
Clinical knowledge of discharge planning competencies.
Knowledge of Medicare and Medicaid regulations.
Knowledge of utilization management processes.

Responsibilities

Develop complex discharge plans based on members’ assessed needs and level-of-care requirements.
Coordinate with providers, community agencies, and utilization review staff to create safe, effective, and clinically appropriate transition plans.
Help manage discharge plans to support timely, smooth transitions between levels of care and facilities.
Collect, document, and maintain discharge plans in member medical records and health management systems according to utilization management policies and guidelines.
Educate members and their families about discharge plans and utilization processes, as applicable.
Provide leadership with feedback on opportunities to improve discharge planning and transitional care.
Coordinate and assist with prior authorizations related to discharge planning, as applicable.
Assist the concurrent review team as needed.
Perform other duties as assigned.
Comply with all policies and standards.