Discharge Planner - Care Management - Per Diem
Company: Martin Luther King, Jr. Community Hospital
Posted on: February 10, 2024
If you are interested please apply online and send your resume
Manages the discharge/transition process by working closely with
the patient and/or family, and coordinating care with the
multidisciplinary team: including physicians, nursing, and
community based organizations, to ensure patient's adequate
post-acute care transition. Applies substantial knowledge and
experience to perform a wide range of advanced activities and/or
determines how to use resources to meet schedules and
organizational goals; serves as lead for team or work group.
ESSENTIAL DUTIES AND RESPONSIBILITIES
- Assists patients through the healthcare system, under the
direction of CM, by operating as a patient advocate and health
- Coordinates continuity of patient care with external healthcare
organizations and facilities.
- Obtains patient choice for post-acute facilities as required by
CMS Conditions of Participation.
- Coordinates referrals to post-acute facilities, including home
care, DME, SNF, LTAC, Acute Rehabilitation based on patient/family
choice when patient has Medicare.
- Coordinates referrals to contracted facilities and vendors for
- Reports care/discharge barriers to appropriate care
- Follow the continuum of patient care for admission to
- Communicates with patients and families with regard to
transition plans, as directed by the Care Manager.
- Promotes clear communication amongst interdisciplinary care
team members by ensuring awareness regarding patient care
- Coordinates special needs and projects as assigned (resource
manuals, complex placement, recuperative care)
- Knowledge of Medicare guidelines for post-acute needs IE:
oxygen, wheelchairs, PT/OT/ST, feeding supplies
- Documents in the patient's medical record for continuum of
- Coordinates transportation arrangements according to insurance
requirements or as needed to meet post discharge needs
- Assists with post-acute needs as requested by CM Leadership or
RN Case Manager.
- Performs other duties as assigned.
- High school diploma or GED required
- Medical Assistant Training preferred
- Two (2) years continuous recent experience in a healthcare
setting as unit clerk /care coordinator or similar position
- A team player that can multitask and can follow details -
knowledge of CMS guidelines preferred
- Highly organized and well developed oral and written
communication, problem-solving, and decision-making skills
C. Special Skills/Knowledge
- Current Basic Life Support (BLS) for Health Care Providers from
the American Heart Association
- Proficient to expert computer skills utilizing Microsoft Office
especially Word and Excel
- Critical thinking
- Bi-lingual Spanish preferred but not required
- Medicare conditions of participation, general knowledge of
Title XX11 benefits for medi-cal recipients
- Must complete annual Workplace Violence Prevention
Program/Certificate, per hospital policy, during initial
training/orientation but not to exceed 30 days from
Keywords: Martin Luther King, Jr. Community Hospital, Alhambra , Discharge Planner - Care Management - Per Diem, Executive , Alhambra, California
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