Discharge Planner LVN — Coordinate Reentry Care & Support

Wellpath; Fresno (CA); On-site; USD 70,000 - 95,000; Full time

Benefits offered by this job

DailyPay

Tuition Assistance and dependent Schor

Employee Assistance Program (EAP)

Company paid life insurance

Health Spending Accounts (HSA)

Wellness program with fitness and shop

Discounted rates for home and auto

Job summary

Wellpath in Fresno, CA is seeking a Nurse Discharge Planner LVN to coordinate clinically informed reentry care plans for CalAIM-eligible individuals. You will assess needs, review records, coordinate referrals, and ensure smooth handoffs to community providers.

Join a mission driven, patient-centered team with emphasis on collaboration, training, and ongoing development. This role offers autonomy in a warm team environment and opportunities to impact outcomes for medically complex patients.

Qualifications

• Graduation from an accredited School of Nursing is required.
• Bachelor's degree in Social Work, Business Administration, or other health-related fields from an accredited college or university is preferred.
• Previous experience in developing successful transition plans involving community resources for persons with medical, substance use, and/or mental illness is preferred.

Responsibilities

• Provide discharge planning services for medically complex patients and related programs per contract.
• Identify release-planning needs, coordinate medications and medical needs upon release, and arrange referrals and appointments.
• Facilitate psychoeducational sessions, benefit applications, and resumption of services to support continuity of care.
• Maintain relationships with facility staff, parole, mental health, and medical partners while adhering to security regulations.
• Document services in the health record, activate required codes, and ensure compliance with CalAIM requirements.

Skills

Nursing

Discharge planning

Healthcare coordination

Education

Licensed Practical Nurse (LPN) / LVN

Bachelor's degree in Social Work (preferred)

Tools

EHR

Job description

Wellpath in Fresno, CA is seeking a Nurse Discharge Planner LVN to coordinate clinically informed reentry care plans for CalAIM-eligible individuals. You will assess needs, review records, coordinate referrals, and ensure smooth handoffs to community providers.

Join a mission driven, patient-centered team with emphasis on collaboration, training, and ongoing development. This role offers autonomy in a warm team environment and opportunities to impact outcomes for medically complex patients.