Sr. Discharge Planning Associate

UPMC • Jamestown, NY

2d • Onsite

About The Position

UPMC Chautauqua is seeking a Senior Discharge Plan Manager to join their Clinical Care Coordination Department. This full-time role primarily involves day shifts, Monday through Friday, and is part of a Discharge Planning Career Ladder dedicated to patient care throughout their UPMC treatment journey. The Senior Discharge Plan Manager is a key role within this career ladder, with the final placement in title and salary determined by experience and education. This position offers the opportunity to work within a multidisciplinary team focused on enhancing care coordination and developing efficient discharge planning processes. UPMC supports employee success through various offerings, including a sign-on bonus, a career ladder for advancement, flexible scheduling, paid time off, holidays, and tuition assistance.

Requirements

• BSN and RN license required. At least three years' experience in discharge planning/care coordination. (10 years of experience can be substituted for BSN completion). OR MSW or master's degree in another health and human services field that promotes the physical, psychosocial, and/or vocational well-being of those being served required. 3 years of experience in discharge planning/care coordination. (10 years of experience can be substituted for MSW completion).
• Knowledge in navigating communications with payer sources and programs.
• Knowledge and understanding of regulatory guidelines.
• Skilled in planning/organization, follow up/control, delegation.
• Skilled in problem solving, self-development, and organizational behaviors/competencies.
• Ability to read, understand, analyze, and interpret medical record documents.
• Ability to apply principles of logic and critical thinking to a wide range of problems and to deal with a variety of abstract and concrete variables.
• Demonstrate ability to function independently, taking initiative to be proactive and drive a discharge plan while working with a multi-disciplinary team.
• Ability to lead care teams to develop and execute safe and efficient discharge plans.
• Maintain knowledge about area resources and their capabilities and capacities as well as various types of service providers.
• Demonstrate understanding of inpatient care setting operations.
• Ability to manage multiple priorities in a fast-paced environment.
• Registered Nurses employed in this position are required to maintain active RN license. OR Those without an active RN license, an LSW/LCSW or education-appropriate license required.

Nice To Haves

• CCM/ACM or other nursing or social work certification preferred.

Responsibilities

• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process with the patient to attain optimal outcomes, considering patient/family/caregiver level of health literacy.
• Evaluate patient/family/caregiver level of understanding and engagement with progress toward goals and incorporate findings into the plan of care.
• Balance resources with patient preferences and goals of care.
• Evaluate the potential impact of social determinants of health that may elevate the risk of a poor transition.
• Complete detailed assessments to understand medical and social factors, determine capacity for self-care, identify support systems, outline barriers to discharge, and determine the likelihood of requiring and availability of post-hospital services.
• Continuously reassess discharge plans for factors affecting continuing care needs or appropriateness.
• Facilitate teams to develop and execute safe and efficient discharges.
• Maintain knowledge about area resources, their capabilities and capacities, and various types of service providers.
• Ensure appropriate arrangements for post-hospital care are made before discharge and work to avoid unnecessary delays.
• Integrate patients' goals, the health care team's assessment, risks, and available resources to develop and coordinate a successful transition plan.
• Engage in clear communication with the patient/member/caregivers and the interdisciplinary care team to develop discharge plans.
• Serve as a liaison between the patient and the care team.
• Collaborate with the attending practitioner, caregivers, and other multidisciplinary team members to coordinate an individualized plan of care.
• Incorporate discipline-specific recommendations, test results, and outstanding orders into the discharge plan and monitor/revise/respond to discharge milestone progression.
• Serve as a contact between hospitals and post-hospital care facilities, as well as physicians in these settings.
• Recognize and demonstrate shared accountability in developing a discharge plan with the patient/member/caregiver and team members for optimal outcomes.
• Align practice with the mission, vision, and values of the organization, adhering to ethical standards and codes of conduct.
• Maintain clinical knowledge and ensure compliance with regulatory requirements.
• Advocate on behalf of patient/family/caregivers for access to services and for the protection of patient's health, well-being, safety, and rights.
• Manage cost of care with patient safety, clinical quality, risk, and patient satisfaction to provide recommendations and decisions for optimal outcomes.
• Embrace and incorporate innovation and technology to improve collaboration and patient outcomes.
• Document care in the patient medical chart.
• Assist in operational activities for the department, including staff orientation and mentoring.
• Demonstrate expertise in the relevant content area.
• Participate in process improvement initiatives.

Benefits

• Up to $10,000 sign-on bonus for eligible roles with a two-year work commitment
• Designated career ladder designed to support career advancement, with two tracks to support both nurses and social workers
• Flexible schedule options
• Up to 5 ½ weeks of paid time off
• 7 paid holidays
• $6,000/year in tuition assistance

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level