Discharge Planner - Ellis Medicine

BASIC FUNCTION:







The Discharge Planner’s primary function is to provide administrative support to the Case Management Department. Responsibilities include maintaining case files, updating referral information, and verifying information related to health insurance or benefits. Role requires interaction with clients, payers, post-acute facility liaisons, performing intake interviews, assistance in implementation of discharge plans to transition patients across the healthcare continuum in conjunction with Case Managers (CM) or Social Workers (SW).







The Discharge Planner’s primary function is to work with the Social Worker, Nurse Case Manager, or Utilization Management Nurse to facilitate patient discharge plans, support coordination of care activities, and assist in utilization management activities under the direction of a registered nurse and/or social worker. Responsibilities include maintaining case files, updating referral information, and verifying information related to health insurance or benefits. Role requires interaction with clients, payers, post-acute facility liaisons, performing intake interviews, assistance in implementation of discharge plans to transition patients across the healthcare continuum.







EDUCATION AND EXPERIENCE REQUIREMENT(S):





+ High School Diploma required. Associate’s Degree in Health Sciences or Licensed Practical Nurse credential strongly preferred. In place of a degree/credential, 10+ years of related healthcare experience.









PHYSICAL REQUIREMENTS:



The position is located indoors under normal working conditions. Should be able to push/pull 25 lb., lift/move 15 lb. from floor to table, be able to perform moderately difficult manual manipulations such as using a key board, writing and filing for extended periods of time, must be able to perform tasks which require hand-eye coordination such as data entry, typing and using photo copiers. Mobility requirements may include the ability to sit at a computer terminal or work station for a prolonged period of time in addition to being able to squat, stand and walk for a reasonable length of time and distance. Sensory requirements include the ability to articulate and comprehend the spoken English language in addition to being able to read the English language.







Discharge Planning Activities:

+ + Contacts referral agencies to make post discharge arrangements for patients.



+ Assists Case Manager or Social Worker by offering choice of providers.



+ Notifies designated facilities of need for admission and verifies bed availability.



+ Updates facilities of patient’s discharge condition and final discharge plans.



+ Assists with ordering durable medical equipment.



+ Meets with patient, family and/or designee to ensure post-acute care referrals are executed to various community partners, financial counselors, medication assistance and/or facilities in conjunction with multidisciplinary team upon determination and/or notification.



+ Identifies obstacles early in the discharge plan implementation process and discusses possible changes/options with the CM/SW and with the patient and their support system and the care team as instructed.



+ Ensure discharge planning documents are provided to post-acute care facilities prior to patient return (ie. NYS Department of Health Forms, etc…)



+ Provide post-acute care referral responses upon receipt and document patient, family and/or designee response



+ Elevate identified barriers to ensure continuity of care and decrease length of stay



+ Appropriately refer and elevate medical and/or complex needs to appropriate case management and social work staff to ensure smooth care transition



+ Coordinate arrangement of durable medical equipment with vendor authorization as needed.



+ Participate in internal and external meetings regarding care transitions and performance improvement initiatives.



+ Prints/copies sections of the chart to fax or send to accepting agencies/facilities to ensure continuation of patient’s treatment plan.



+ Arranges transportation as directed by the Case Manager or Social Worker.



+ Demonstrates knowledge of Discharge Planning resources available in the area.



+ Documents discharge planning activities in the chart.



+ Keeps the CM, SW, patient and their support system and the care team updated on progress or changes in the discharge plan.



+ Assists Case Manager with medication prior authorizations.



+ Provides Medicare Important Message to Medicare beneficiaries per CMS Conditions of Participation at the direction of the Case Manager.







+ Utilization Management Activities:



+ Collaborates with Case Managers and other team members for optimal Utilization Management information throughout the continuum.



+ Maintains relationships with payers and communicates confidential information per policy.



+ Assists Utilization Management with initial clinical review requests as needed.



+ Notifies Case Manager of any potential delays of moving the patient through the continuum.



+ Maintains accurate, up-to-date documentation in the medical record.



+ Documents Utilization Management activities in MIDAS per policy.



+ Prints/copies the chart to fax or send for insurance denials or quality improvement organization appeals.



+ Assists UM Coordinator with data entry of insurance authorizations and denials.







+ Denial Management Activities



+ Assists Denial Management staff with clerical support; including facilitating MD to MD reviews.



+ Performs audit activities under the supervision of the Director of Case Management and Social Work Services.