Discharge Planner Per Diem Days

MLK Community Healthcare•Los Angeles, CA

2d•Onsite

About The Position

Manages the discharge/transition process by working closely with the patient and/or family, and coordinating care with the multidisciplinary team: including physicians, nursing, and community based organizations, to ensure patient's adequate post-acute care transition. Applies substantial knowledge and experience to perform a wide range of advanced activities and/or determines how to use resources to meet schedules and organizational goals; serves as lead for team or work group.

Requirements

High school diploma or GED required.
Two (2) years continuous recent experience in a healthcare setting as unit clerk /care coordinator or similar position required.
A team player that can multitask and can follow details.
Highly organized and well developed oral and written communication, problem-solving, and decision-making skills.
Current Basic Life Support (BLS) for Health Care Providers from the American Heart Association.
Proficient to expert computer skills utilizing Microsoft Office especially Word and Excel.
Critical thinking.
Resourcefulness.

Nice To Haves

Medical Assistant Training preferred.
Knowledge of CMS guidelines preferred.
Bi-lingual Spanish preferred but not required.
Medicare conditions of participation, general knowledge of Title XX11 benefits for medi-cal recipients.

Responsibilities

Assists patients through the healthcare system by operating as a patient advocate and health systems navigator.
Coordinates continuity of patient care with external healthcare organizations and facilities.
Obtains patient choice for post-acute facilities as required by CMS Conditions of Participation.
Coordinates referrals to post-acute facilities, including home care, DME, SNF, LTAC, Acute Rehabilitation based on patient/family choice when patient has Medicare.
Coordinates referrals to contracted facilities and vendors for managed care.
Reports care/discharge barriers to appropriate care manager.
Follow the continuum of patient care for admission to post-discharge.
Communicates with patients and families with regard to transition plans, as directed by the Care Manager.
Promotes clear communication amongst interdisciplinary care team members by ensuring awareness regarding patient care plans.
Coordinates special needs and projects as assigned (resource manuals, complex placement, recuperative care).
Knowledge of Medicare guidelines for post-acute needs IE: oxygen, wheelchairs, PT/OT/ST, feeding supplies.
Documents in the patient’s medical record for continuum of care.
Coordinates transportation arrangements according to insurance requirements or as needed to meet post discharge needs.
Assists with post-acute needs as requested by CM Leadership or RN Case Manager.
Provides education to patient and/or family in the use of equipment as needed.
Attends Physician or Bedside Rounds as directed by the Case Manager or CM Manager.
May be requested to perform data collection or provide reports.
Take the initiative with delivering care.
Assist with higher level of care.
Performs other duties as assigned.