Discharge Planning Leader — Care Coordination Expert

Upmc Passavant; Pittsburgh (Allegheny County); On-site; USD 37,000 - 62,000; Full time

Benefits offered by this job

Sign-on bonus

Tuition assistance

Career ladder

Flexible schedule

Job summary

UPMC Passavant is seeking professionals in care management roles to coordinate discharge planning and post-hospital care. The team emphasizes an integrated approach with nurses and social workers and offers a structured career ladder and sign-on incentives.

Positions are on-site at 9100 Babcock Blvd, Pittsburgh, with a flexible schedule and advancement opportunities within the Care Management department. The work advances patient outcomes through collaborative care planning.

Qualifications

• Excellent communication skills required.
• Strong planning and organizational abilities.
• Problem solving and critical thinking.
• Ability to work independently and in a team.
• Proficient computer skills.

Responsibilities

• Work with patients throughout their treatment journey — from admission to post-discharge — to ensure patients are prepared for a successful discharge and achieve continued improvement following inpatient care.
• Advocate on behalf of patient/family/caregivers for access to services and for protecting the patient’s health, well-being, safety, and rights.
• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process with the patient to attain optimal outcomes.
• Complete detailed patient assessments to determine patients’ capacity for self-care, identify support systems, outline barriers to discharge, and determine the likelihood that patients will require post-hospital services and the availability of those services.
• Collaborate with a multidisciplinary team to coordinate an individualized, safe, efficient care plan. Integrate patients’ goals, the health care team’s assessment, risks, and available resources to develop and coordinate a successful transition plan.
• Serve as a liaison between patients and the care team. Incorporate discipline-specific recommendations, test results, and outstanding orders into the discharge plan and respond to the progression of discharge milestones.
• Maintain knowledge of resources in the area, their capabilities and capacities, and service providers available. Ensure appropriate arrangements for post-hospital care will be made before discharge and work to avoid unnecessary delays in discharge.
• Serve as a contact between hospitals and post-hospital care facilities and the physicians who provide care in both settings.

Skills

Communication skills

Planning skills

Problem solving

Team collaboration

Computer skills

Education

Nurse track: Diploma or Associate’s Degree

Non-nurse track: Bachelor’s degree in social work or another health/human services field

Master’s degree preferred

Job description

UPMC Passavant is seeking professionals in care management roles to coordinate discharge planning and post-hospital care. The team emphasizes an integrated approach with nurses and social workers and offers a structured career ladder and sign-on incentives.

Positions are on-site at 9100 Babcock Blvd, Pittsburgh, with a flexible schedule and advancement opportunities within the Care Management department. The work advances patient outcomes through collaborative care planning.