Discharge Planner - Care Management - Per Diem

If you are interested please apply online and send your resume to MarisMartinez@mlkch.org

POSITION SUMMARY

Manages the discharge/transition process by working closely with the patient and/or family, and coordinating care with the multidisciplinary team: including physicians, nursing, and community based organizations, to ensure patient's adequate post-acute care transition. Applies substantial knowledge and experience to perform a wide range of advanced activities and/or determines how to use resources to meet schedules and organizational goals; serves as lead for team or work group.

ESSENTIAL DUTIES AND RESPONSIBILITIES

• Assists patients through the healthcare system, under the direction of CM, by operating as a patient advocate and health systems navigator.

• Coordinates continuity of patient care with external healthcare organizations and facilities.

• Obtains patient choice for post-acute facilities as required by CMS Conditions of Participation.

• Coordinates referrals to post-acute facilities, including home care, DME, SNF, LTAC, Acute Rehabilitation based on patient/family choice when patient has Medicare.

• Coordinates referrals to contracted facilities and vendors for managed care.

• Reports care/discharge barriers to appropriate care manager.

• Follow the continuum of patient care for admission to post-discharge.

• Communicates with patients and families with regard to transition plans, as directed by the Care Manager.

• Promotes clear communication amongst interdisciplinary care team members by ensuring awareness regarding patient care plans.

• Coordinates special needs and projects as assigned (resource manuals, complex placement, recuperative care)

• Knowledge of Medicare guidelines for post-acute needs IE: oxygen, wheelchairs, PT/OT/ST, feeding supplies

• Documents in the patient's medical record for continuum of care.

• Coordinates transportation arrangements according to insurance requirements or as needed to meet post discharge needs

• Assists with post-acute needs as requested by CM Leadership or RN Case Manager.

• Performs other duties as assigned.

POSITION REQUIREMENTS

A. Education

• High school diploma or GED required

• Medical Assistant Training preferred

B. Qualifications/Experience

• Two (2) years continuous recent experience in a healthcare setting as unit clerk /care coordinator or similar position required.

• A team player that can multitask and can follow details - knowledge of CMS guidelines preferred

• Highly organized and well developed oral and written communication, problem-solving, and decision-making skills

C. Special Skills/Knowledge

• Current Basic Life Support (BLS) for Health Care Providers from the American Heart Association

• Proficient to expert computer skills utilizing Microsoft Office especially Word and Excel

• Critical thinking

• Resourcefulness

• Bi-lingual Spanish preferred but not required

• Medicare conditions of participation, general knowledge of Title XX11 benefits for medi-cal recipients

• Must complete annual Workplace Violence Prevention Program/Certificate, per hospital policy, during initial training/orientation but not to exceed 30 days from hire/transfer.

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