PURPOSE STATEMENT Collaborates with the Case Management department to assist in facilitating appropriate post-acute patient placement, utilizing hospital and community resources for continuity of patient care. ESSENTIAL FUNCTIONS Assist with initial discharge planning assessment of patient population, establishing patient and family needs post discharge. Assist with post-acute patient placement and discharge needs, including but not limited to skilled nursing facility referrals, arrangements for transportation, home medical equipment, home infusion therapy, hospice referrals and home health services. Facilitate the second issuance of the Important Message for all Medicare patients and document issuance in the patient record. Identify patients in need of assistance in acquiring medications for post-acute care and make arrangements for procurement. Participate in multidisciplinary team rounds for review of patient’s plan of care, discharge planning and utilization management, collaborating with team members to address patient needs and desired outcomes. Provide patient/family with information about post hospital care placement options, ensures patient choice and obtains necessary consents to refer patient to appropriate facility/services. Maintain expertise regarding community resources. Advocate for the patient and family throughout the entire episode of care, maintains availability to the patient/family as a resource to facilitate communication among providers and enables patient/family to make informed decisions. Assist with documentation and capturing of department metrics as directed by the UM Plan (i.e. avoidable days, delays, interventions, etc.). Display a high level of flexibility, adaptability and organizational skills in response to the workload and effectively prioritizes work while maintaining productivity. Cooperate with changes in staffing schedules to achieve department productivity standards. Participate in department based Performance Improvement activities. Participate in department activities and provides input when appropriate. Contribute to the development of competencies related to job functions and participates in competency evaluations. Demonstrate attendance patterns to reflect commitment to the job requirements and patient care needs. Demonstrate a working knowledge of HIPAA guidelines and utilizes them in all aspects of communication with patients and families. Maintain regular and predictable attendance. Perform other essential duties as assigned
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Job Type
Full-time
Career Level
Entry Level
Number of Employees
101-250 employees