Discharge Planner Jobs

About The Position

Requirements

• Associate degree in a health-related field.
• Three years of experience in a health-related field.

Nice To Haves

• Working knowledge of discharge planning and community resources.

Responsibilities

• Engage patients and families in discharge planning and provide educational resources about service choices, costs, and scope under the direction of senior staff.
• Facilitate referrals to home care agencies, rehabilitation providers, durable medical equipment vendors, home infusion vendors, home labs, and other programs as directed by the Clinical Care Manager.
• Assist with prior approval or preauthorization from insurance for post-acute care services.
• Identify and address barriers by providing information and referrals to entitlement and insurance programs, hospital resources, and community organizations.
• Explain the Medicare Important Notice, appeal rights, and qualifying hospital-stay requirements for subacute rehabilitation coverage when appropriate.
• Facilitate patient transfers in accordance with hospital policies, applicable state and federal regulations, and Joint Commission standards.
• Document information pertinent to the transitional plan of care and clearly document the discharge plan for post-hospital care providers.
• Provide patients and families with information about discharge planning, length of stay, appropriate use of health care resources, and the appeal process.
• Make timely referrals to community services based on identified needs to ensure continuity of care.
• Advocate for culturally competent care and information appropriate to patients’ literacy levels.
• Escalate patient quality concerns to the Clinical Care Manager or unit leadership, attend Patient Safety and Quality reviews as needed, and report variances through established quality-improvement processes.
• Verify patient identification before discharge handoff to external providers.
• Identify and appropriately document avoidable days that contributed to increased length of stay.
• Use the teach-back process to ensure patients and families understand the discharge plan.
• Identify variances in care and escalate them to the Clinical Care Manager or local leadership.
• Support timely progression to appropriate levels of care and advocate for care in the right setting and at the right level.
• Ensure discharge arrangements are timely to facilitate patient flow.
• Serve as a role model in support of the hospital mission and participate in unit-based interdisciplinary meetings in a patient-centric manner.
• Develop and mentor C2 Discharge Planning staff as necessary, foster teamwork, and recognize team members’ strengths and expertise to develop and implement patient-centric plans.