Discharge Planning Assistant - Care Management - 8a-4:30p

Trinity Health•Ann Arbor, MI

About The Position

Responsible for facilitating patient transfer and/or transportation to alternative care settings i.e., Extended Care Facilities (ECFs), home, home with ongoing therapy, based on referral from Social Worker or Case Manager. Coordinates the referral and transfer of patients in an efficient and cost effective manner. Provides quality patient care considering age specific, developmental and cultural needs. Demonstrates unit/area designated competencies. General Summary Responsible for facilitating patient transfer and/or transportation to alternative care settings i.e., Extended Care Facilities (ECFs), home, home with ongoing therapy, based on referral from Social Worker or Case Manager. Coordinates the referral and transfer of patients in an efficient and cost effective manner. Provides quality patient care considering age specific, developmental and cultural needs. Demonstrates unit/area designated competencies.

Requirements

High school diploma required or equivalent and one year of specialized training including medical terminology.
One to two years or Healthcare Experience.
Interpersonal skills necessary to communicate effectively with Social Work & Case Management Department staff, and external agencies when gathering and exchanging appropriate patient information.
Analytical skills necessary to gather and document patient clinical status and to facilitate transfer of patient.
Organizational skills in order to assess urgency and complexity of referral and to facilitate appropriate and timely patient transfer.
Basic computer skills.

Responsibilities

Completes screening of patients' medical records and documentation of relevant clinical information via continuity of care tools i.e., ECF forms, and maintains accurate record of status of activities related to discharge plan.
Facilitates referrals to community agencies as directed by Social Worker/Case Manager arranging transfer and/or transportation of patients to ECFs or home care settings with external agencies i.e., ECF, ambulance, wheelchair van.
Collaborates with Social Worker/Case Manager to facilitate appropriate placement of patients to ECFs based on data obtained via Social Worker, patient medical record, PCIS, i.e., medical needs, reimbursement sources, patient/family choices.
Communicates with ECFs to facilitate appropriate patient placement taking into consideration: a. patient/family desires b. patient clinical condition and needs c. patient insurance coverage
Investigates patient's insurance coverage for long term care and/or outpatient care, as needed to facilitate resolution of insurance coverage issues related to ECF transfer.
Develops strong working relationships with various community agencies in order to promote expedient transfers.
Maintains awareness of State and Federal Regulations and reimbursement issues as they pertain to continuity of care needs, ECF planning, and/or transportation processes.
Provides information to Social Work and Case Management Department staff regarding changes and new developments in reimbursement and agency policies, and community resources
Participates in orientation of new Social Work and Case Management Department staff regarding ECF and/or transportation work processes.
Compiles departmental statistics regarding patient transfers for the purpose of preparing monthly and annual departmental activity reports as well as special studies related to length of stay.
Develops, reviews and modifies referral tools and systems to enhance continuity of care planning processes.
Independently organizes and sets priorities.
Maintains good rapport and cooperative relationships.
Approaches conflict in a constructive manner.
Helps to identify problems, offers solutions and participates in their resolution.
Maintains the confidentiality of information acquired pertaining to patients, physicians, employees, and visitors to St. Joseph Mercy Hospital. Discusses patient and hospital information only among appropriate personnel in appropriately private places.
Assumes responsibility for performance of job duties in the safest possible manner, to assure personal safety and that of coworkers, and to report all preventable hazards and unsafe practices immediately to management.
Behaves in accordance with the Mission, Vision and Values of St. Joseph Mercy Health System.
This document is intended to describe the generalized duties and responsibilities, the specialized job functions, and the essential requirements of this job. It is not intended to be an exhaustive statement of all supplemental duties, responsibilities, or non-essential requirements or reflect any accommodations made under the American’s with Disability Act, the Michigan Handicapper’s Act, or SJMHS’s Return to Work Program.