Discharge Planner

WVU Medicine

22d

About The Position

Functions as a member of the interdisciplinary treatment team with primary responsibility for initial assessments, discharge planning and other case management responsibilities. Will perform case management tasks with minimal supervision consistent with the developmental age of the patients served.

Requirements

Bachelor’s degree in Social Work, Psychology, Sociology, Nursing, or related field.
State criminal background check and Federal (if applicable), as required for regulated areas.
Must have independent decision-making ability.
Ability to work with multi-disciplinary groups and facilitate meetings.
Ability to work independently or cooperatively as a team member.

Nice To Haves

One (1) year experience in a healthcare setting.

Responsibilities

Participates as an integral professional member of an interdisciplinary team.
Collects and records data that is comprehensive, accurate, and systematic in the assessment form and in progress notes.
Assesses and documents in the medical record the discharge planning needs of the patient.
Contacts the referral source(s) and appropriate health professionals involved in the patient’s discharge status and to obtain any additional information that might facilitate the treatment process.
Advocates on behalf of the patient to maximize available services.
Assists treatment team by coordinating planning effort. Assists in determining appropriateness of admissions and receives referrals for discharge planning intervention.
Establishes and maintains a collaborative environment in coordination with the patient and other healthcare providers.
Assists patients and families in achieving a satisfying and productive discharge plan through health teaching and documents teaching according to hospital policy.
Performs discharge planning as developed with the treatment team from day of admission. Acts as liaison for patients and their families to various community agencies, hospital consultants and services.
Participates in improving organizational performance and other means of evaluation to assure quality of nursing and discharge planning services provided for patients.
Attends continuing education seminars and in-services as necessary to maintain professional licensure, competency, and to satisfy hospital-required educational standards.
Coordinates post-acute care planning including referrals to skilled nursing, rehabilitation, home health, or durable medical equipment providers.
Provides education to patients and families to support discharge readiness and ensure understanding of post-discharge instructions and available services.
Demonstrates working knowledge of Medicare, Medicaid, and private insurance guidelines relevant to post-acute services and transitions of care.
Provides timely documentation of discharge planning activities, patient/family communications, and care coordination in accordance with hospital policy and regulatory standards.
Collaborates with case managers, utilization review, and third-party payors to support timely transitions and resolve coverage or authorization issues.
Assists patients and families in navigating community-based resources, including transportation, housing, or medical support programs.
Participates in weekend or holiday rotations as needed to ensure continuity of discharge planning services if applicable for your assigned unit.