Discharge Planning Nurse Navigator

Penn Medicine; Philadelphia (Philadelphia County); On-site; USD 75,000 - 95,000; Full time

Benefits offered by this job

Prepaid tuition assistance

Job summary

Penn Medicine is seeking a Registered Nurse with PA licensure to lead discharge planning activities and coordinate post-hospital care, including home care, DME, hospice, and community resources. You will partner with patients and families to ensure options are available and that care plans align with insurance benefits and personal preferences.

The role requires strong communication, adherence to privacy, and the ability to navigate healthcare systems and EPIC documentation.

Qualifications

• Registered Nurse - PA (Required)
• Bachelor's degree (BA/BS) required.

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.
• Recognizes and provides care based on the unique chronological issues and needs of the older adult.
• 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.
• New Technology / Computer Systems:
• Keeps current with new systems (SafetyNet, Penn Chart, Haiku, etc.).
• Incorporates technology into daily assignment (Outlook, Microsoft Teams, shared drive, Internet).

Education

Bachelor of Arts or Science (Required)

Job description

Penn Medicine is seeking a Registered Nurse with PA licensure to lead discharge planning activities and coordinate post-hospital care, including home care, DME, hospice, and community resources. You will partner with patients and families to ensure options are available and that care plans align with insurance benefits and personal preferences.

The role requires strong communication, adherence to privacy, and the ability to navigate healthcare systems and EPIC documentation.