Discharge Planning Assistant

Trinity Health•Ann Arbor, MI

About The Position

The Discharge Planning Assistant facilitates patient transfers and transportation to alternative care settings, including extended care facilities (ECFs), home, and home with ongoing therapy, based on referrals from Social Workers or Case Managers. The role coordinates referrals and transfers efficiently and cost-effectively while providing quality patient care that considers age-specific, developmental, and cultural needs and meeting designated unit or area competencies. The assistant screens medical records, documents relevant clinical information using continuity-of-care tools, and tracks discharge-planning activities. Working with Social Workers and Case Managers, the role coordinates community-agency referrals, patient placement, and transportation; communicates with ECFs; investigates insurance coverage; and helps resolve coverage issues. The position also maintains working relationships with community agencies, monitors relevant regulations and reimbursement developments, shares updates with department staff, supports staff orientation, compiles transfer statistics, and improves referral tools and systems. The role requires independent organization and prioritization, constructive collaboration, confidentiality, safe work practices, and conduct consistent with the Mission, Vision, and Values of St. Joseph Mercy Health System.

Requirements

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

Responsibilities

Screen patients’ medical records and document relevant clinical information using continuity-of-care tools, while maintaining accurate records of discharge-planning activity.
Facilitate referrals to community agencies as directed by Social Workers or Case Managers, arranging patient transfers and transportation to ECFs or home-care settings with external agencies.
Collaborate with Social Workers and Case Managers to support appropriate ECF placement based on medical needs, reimbursement sources, and patient or family choices.
Communicate with ECFs to facilitate placement while considering patient and family preferences, clinical condition and needs, and insurance coverage.
Investigate insurance coverage for long-term care or outpatient care as needed to help resolve issues related to ECF transfers.
Develop working relationships with community agencies to promote timely transfers.
Maintain awareness of state and federal regulations and reimbursement issues affecting continuity of care, ECF planning, and transportation.
Provide department staff with information about reimbursement and agency-policy changes, developments, and community resources.
Participate in orienting new Social Work and Case Management Department staff to ECF and transportation processes.
Compile statistics on patient transfers for monthly and annual departmental reports and special studies related to length of stay.
Develop, review, and modify referral tools and systems to improve continuity-of-care planning.
Organize work and set priorities independently.
Maintain cooperative relationships, address conflict constructively, identify problems, offer solutions, and participate in resolution.
Protect confidential information about patients, physicians, employees, and visitors, discussing patient and hospital information only with appropriate personnel and in private settings.
Perform duties safely, protect personal and coworker safety, and promptly report preventable hazards and unsafe practices to management.
Behave in accordance with the Mission, Vision, and Values of St. Joseph Mercy Health System.