Discharge Planner

Reid Health; Richmond (IN); On-site; USD 52,000 - 76,000; Full time

Job summary

Reid Health in Indiana is seeking a Discharge Planner to coordinate patient transitions from hospital to post-acute care. You will work with Case Management and interdisciplinary teams to develop transition plans, refer to post-hospital services, and ensure timely, safe discharges for patients in the Richmond area.

The role emphasizes psycho-social and financial aspects, collaboration with families, and thorough documentation of transition activities in the medical record.

Qualifications

• Bachelor's degree in Social Work or equivalent field.
• Master's degree in Social Work or equivalent field preferred.
• 1 year of experience in a healthcare setting as a social worker or equivalent field.
• 3–5 years experience in healthcare setting as a social worker or equivalent field preferred.

Responsibilities

• Works with Case Manager and interdisciplinary team to identify patient transition plans and coordinate timely discharge/transfer.
• Coordinates post-hospitalization services for patients identified by the team.
• Understand the patient’s planned course of treatment to anticipate transition readiness and coordinate discharge/transfer.
• Starts referrals promptly to begin payer authorization and avoid delays.
• Collaborates with patient/family to select post-hospitalization care arrangements and documents relationships with vendors.
• Keeps patient/family, Case Manager, and healthcare team informed.
• Communicates information to the agency/facility assuming continuing care after discharge and documents it.
• Documents all transition activities in the medical record.
• Makes referrals to other department services to expedite safe discharge.
• Trends, analyzes and reports outcomes and process data to stakeholders.
• Participates in improvement activities and practice changes as needed.
• Attends meetings with physicians and Nurse Leaders to report trends and outcomes.

Education

Bachelor's degree in Social Work or equivalent field

Master's degree in Social Work or equivalent field

Job description

7460 Patient Resources Services
Schedule: Day Shift. 40 hours weekly. 8:00a-4:30p. Occasional weekend and holiday rotation.
Type additional details specific to position and/or department.

About The Position

The Discharge Planner coordinates patient transition along the healthcare continuum through assessments, referrals and interdisciplinary planning. Coordinates the posthospitalization services as outlined in the patient’s transition plan. The Discharge Planner provides the necessary focus on the patient’s psycho-social, financial, and transition needs in order to promote optimal outcomes including reducing related and unplanned re-hospitalization. Refers patients to appropriate community services and resources. Alerts members of the interdisciplinary team to psycho-social and financial issues risk factors. The Discharge Planner applies the use of data in his/her practice; identifying where to focus efforts, the measurement of progress towards identified outcomes, and as an educational tool.

Overview Of Responsibilities

• Works collaboratively with the Case Manager and interdisciplinary team to identify and establish patient transition plans and coordinates a timely, safe patient discharge/transfer.
• Coordinates post-hospitalization services for patients as identified by the interdisciplinary team.
• Understands the patient’s planned course of treatment to the degree necessary in order to anticipate “transition readiness” and coordinate a timely discharge/transfer.
• Starts referrals timely to ensure the payer authorization process can begin early and avoid delays, as applicable.
• Collaborates with the patient/family in the selection and making of post-hospitalization care arrangements; offers patients a choice of vendors. Discloses which vendors have a financial relationship with the hospital and documents both; follows Transition Management Policy.
• Keeps the patient/family, Case Manager, and healthcare team well informed.
• Communicates the relevant information to the agency/facility that will assume responsibility for continuing care after the patient’s release and documents as such.
• Documents all transition coordination activities and interventions in the medical record.
• Makes referrals to other department services as applicable to the patient’s needs to expedite a safe and timely discharge.
• Trends, analyzes, and reports outcomes, clinical process, and variance data to appropriate audiences.
• Participates in process and outcome improvement activities and helps facilitate approved practice changes.
• For the assigned population, attends appropriate physician and Nurse Leader meetings to report on trends, outcomes, and statistics. Receives and acts on feedback from physicians and nursing management related to Discharge Planning.
• Participates in all appropriate and/or required hospital-wide progress activities and efforts.
• Performs other duties as assigned to accomplish the goals of the organization.

This list of duties and responsibilities is not intended to be all-inclusive and can be expanded to include other duties or responsibilities that management deems necessary.

Education & Experience

• Minimum education required: Bachelor's degree in Social Work or equivalent field.
• Minimum education preferred: Mater's degree in Social Work or equivalent field.
• Minimum experience required: 1 year of experience in a healthcare setting as a social worker or equivalent field.
• Minimum experience preferred: 3-5 years experience in healthcare setting as a social worker or equivalent field.