Discharge Planning Associate - Clinical Care Coordination and Discharge Planning

Clinical Care Coordination and Discharge Planning is looking for a Discharge Planning Associate to join their team! The right candidate will be hard working, able to take initiative, and be adaptable. The Clinical Care Coordination and Discharge Planning role is to assist patients to transitioning to the next level of care. Our team meets with patients through the duration of their stay and complete post discharge phone calls to follow up on the patients transition of care. 

This is position is Sign-On Bonus Eligible offering a $6,000 Sign-On Bonus with a two-year employment commitment!

This a full-time position with many schedule options to fit your lifestyle:

• Four 10-hour days (7:30am - 6:00pm)
• Five 8 hour days (7:30am - 4:00pm)

Other highlights:

• 8 step career ladder ranging from entry to director-level leadership
• MSW and MSN programs are free through partnership with Capella University.
• Tuition reimbursement for ACMA certification and membership

Job title and salary will be determined based upon qualifications and career ladder requirements.

In conjunction with the Discharge Planning team, the Associate coordinates the appropriate support services and resources throughout UPMC to facilitate effective discharge plans that achieve optimal satisfaction, clinical, and financial outcomes along the defined continuum of care.

Responsibilities:

• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process with the patient to attain optimal outcomes.
• Take patient/family/caregiver level of health literacy into consideration. 
• Evaluate patient/family/caregiver level of understanding and engagement with the progress toward goals and incorporate findings into the plan of care.
• Balances resources with patient preferences and goals of care. 
• Evaluate the potential impact of social determinants of health that may elevate the risk of a poor transition.
• Complete detailed assessment on every patient in order to establish understanding of medical and social factors, determine patient's capacity for self-care, identify support systems, outline barriers to discharge, and determine likeliness of requiring post-hospital services and the availability of such services.
• Continually reassess discharge plan for factors that may affect continuing care needs or the appropriateness of the discharge plan.
• Facilitate teams to develop and execute safe and efficient discharges.
• Maintain knowledge about area resources and their capabilities and capacities as well as various types of service providers available.
• Ensure appropriate arrangements for post-hospital care will be made before discharge and work to avoid unnecessary delays in discharge.
• Integrate patients' goals, the health care team's assessment, risks and available resources in order to develop and coordinate a successful transition plan.
• Engage in clear communication with the patient/member/caregivers as well as the interdisciplinary care team in order to develop discharge plans.
• Serve as a liaison between the patient and the care team.
• Actively collaborate with the attending practitioner, caregivers, and other members of the multidisciplinary team to coordinate an individualized plan of care.
• Incorporate discipline-specific recommendations, test results, outstanding orders into discharge plan and monitor/revise and respond to the progression of discharge milestone.
• Serve as a contact between hospitals and post-hospital care facilities as well as the physicians who provide care in either or both of these settings.
• Recognize and demonstrate shared accountability in development of a discharge plan with the patient/member/caregiver as well as with team members to ensure optimal outcomes.
• Align practice with the mission, vision, and values of the organization.
• Adheres to ethical standards and codes of conduct of applicable professional organization and UPMC. 
• Maintain clinical knowledge of and ensures compliance with regulatory requirements.
• Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient's health, well-being, safety, and rights.
• Manage cost of care with the benefits of patient safety, clinical quality, risk and patient satisfaction to provide recommendations and decisions that ensure optimal outcomes.
• Embrace and incorporate innovation and technology to improve collaboration and patient outcomes. Document care in patient medical chart.
• Provide staff orientation and mentoring as appropriate.

If you would like to discuss this opportunity and more with a Recruiter for Hamot Nursing and Nursing Support, you can schedule an appointment to meet with us during our virtual office hours!

We are available Mondays and Wednesdays 8AM-10AM, 12PM-2PM, 5PM-7PM. We are also available every first Saturday of the month by request, please email morrisonlm2@upmc.edu to request Saturdays.

 Please click this link to schedule an appointment: Hamot Recruiter Office Hours Scheduling