Discharge Planner

Description: PURPOSE STATEMENT Collaborates with the Case Management department to assist in facilitating appropriate post-acute patient placement, utilizing hospital and community resources for continuity of patient care. ESSENTIAL FUNCTIONS Assist with initial discharge planning assessment of patient population, establishing patient and family needs post discharge. Assist with post-acute patient placement and discharge needs, including but not limited to skilled nursing facility referrals, arrangements for transportation, home medical equipment, home infusion therapy, hospice referrals and home health services. Facilitate the second issuance of the Important Message for all Medicare patients and document issuance in the patient record. Identify patients in need of assistance in acquiring medications for post-acute care and make arrangements for procurement. Participate in multidisciplinary team rounds for review of patient’s plan of care, discharge planning and utilization management, collaborating with team members to address patient needs and desired outcomes. Provide patient/family with information about post hospital care placement options, ensure patient choice and obtain necessary consents to refer patient to appropriate facility/services. Maintain expertise regarding community resources. Advocate for the patient and family throughout the entire episode of care, maintains availability to the patient/family as a resource to facilitate communication among providers and enables patient/family to make informed decisions. Assist with documentation and capturing department metrics as directed by the UM Plan (i.e. avoidable days, delays, interventions, etc.). Display a high level of flexibility, adaptability, and organizational skills in response to the workload and effectively prioritize work while maintaining productivity. Cooperate with changes in staffing schedules to achieve department productivity standards. Participate in department-based Performance Improvement activities. Participate in department activities and provide input when appropriate. Contribute to the development of competencies related to job functions and participate in competency evaluations. Demonstrate attendance patterns to reflect commitment to the job requirements and patient care needs. Demonstrate a working knowledge of HIPAA guidelines and utilize them in all aspects of communication with patients and families. Maintain regular and predictable attendance. Perform other essential duties as assigned. Requirements: EDUCATION/EXPERIENCE/SKILL REQUIREMENTS High school diploma or equivalent. Bachelor’s degree in Social Work or similar field required. Licensed Clinical Social Worker (LCSW) or Licensed Master Social Worker (LMSW) preferred. Current AHA or Red Cross BLS required. 1-3 years hospital based acute care experience preferred. Ability to work independently as well as take direction. Strong written and verbal skills. Effective interpersonal skills. Must be self-motivated and have the ability to work within the established policies, procedures and practices prescribed by the hospital/clinic. PHYSICAL/MENTAL REQUIREMENTS Must be able to sit and stand, intermittent 8 to 10 hours a day. Must be able to use standard office equipment, including the telephone and computer keyboard. Continuously works under pressure of near 100% accuracy while meeting inflexible deadlines. Continuously utilizes manual/bi-manual dexterity, near vision, speech, and hearing.

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