Discharge & Care Coordination Nurse

Penn Medicine, University of Pennsylvania Health System; Philadelphia (Philadelphia County); On-site; USD 75,000 - 95,000; Full time

Job summary

Penn Medicine in Philadelphia seeks a Registered Nurse to support discharge planning, coordinating home care, DME, hospice, and community resources for patients across care settings.

You will educate patients and families about healthcare benefits, ensure timely transfers, document plans in the chart, and collaborate with interdisciplinary teams to promote safe transitions and quality outcomes.

Qualifications

• Registered Nurse - PA (Required)
• 2+ years Clinical Experience

Responsibilities

• Discharge planning activities: timely coordination of home care, DME, placements, hospice, community resources, transportation, and other discharge planning needs as they arise.
• Works with patient and family to assure provision of choice in post hospital setting.
• Educates patient / customers regarding scope and limitations of health care / insurance benefits.
• Respects each patient’s / customer’s personal dignity, right to privacy and confidentiality.
• Communicates expected discharge time frame.
• Keeps current with new providers, new technologies and treatment modalities, and new resources using internet and other sources.
• Interacts with the patient and family in a developmentally appropriate manner.
• Discharge Planning: Completes timely and detailed assessment of patient and family social, emotional and/or discharge needs and health care benefits.
• Develops and facilitates specific plan to address problems and/or concerns identified by patients, families and health care team.
• Identifies and consistently documents delays elevates issues appropriately.
• Effectively communicates discharge plan with patients, families and health care team.Documents ongoing assessments and plan of care in patient record (EPIC).
• Successfully assists patient in moving to the next level of care with transfers to home, agencies, and facilities and with referral to appropriate community resources.
• Participates and drives accountability in daily interdisciplinary meetings.

Education

Bachelor of Arts or Science (Required)

Job description

Penn Medicine in Philadelphia seeks a Registered Nurse to support discharge planning, coordinating home care, DME, hospice, and community resources for patients across care settings.

You will educate patients and families about healthcare benefits, ensure timely transfers, document plans in the chart, and collaborate with interdisciplinary teams to promote safe transitions and quality outcomes.