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Discharge Planner - Care Management - Per Diem

Company: Martin Luther King, Jr. Community Hospital
Location: Alhambra
Posted on: February 10, 2024

Job Description:

If you are interested please apply online and send your resume to


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.


  • Assists patients through the healthcare system, under the direction of CM, by operating as a patient advocate and health systems navigator.
  • 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 managed care.
    • Reports care/discharge barriers to appropriate care manager.
    • Follow the continuum of patient care for admission to post-discharge.
    • 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 plans.
    • 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 care.
    • 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.


      A. Education
      • High school diploma or GED required
      • Medical Assistant Training preferred
        B. Qualifications/Experience
        • Two (2) years continuous recent experience in a healthcare setting as unit clerk /care coordinator or similar position required.
        • 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
          • Resourcefulness
          • 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 hire/transfer.

            MLKCH Video

Keywords: Martin Luther King, Jr. Community Hospital, Alhambra , Discharge Planner - Care Management - Per Diem, Executive , Alhambra, California

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