Complex Discharge Planner

Position Purpose

Develops, assesses, and coordinates complex discharge plans for high-risk members based upon needs assessment. Assists with the facilitation of a smooth transition from the acute care setting to the next level of care and educates members and their families/caregivers on discharge plan to ensure appropriate high-quality transitional care.

Key Details

This position is remote/work from home. The hiring leader prefers an RN with a compact nursing license as the role will support our Market Place/Ambetter and Medicaid members in multiple states. We are looking for RNs with LTAC, Inpatient Rehab. or Skilled Nursing Facility experience to support this Utilization Management role. The work schedule is Monday - Friday, 8am - 5pm based on the time zone in which you reside.

• Develops complex discharge plans based on level of care of members needs determined by needs assessment to ensure appropriate level of care
• Interacts with providers, community agencies, and other utilization review staff to coordinate and ensure a safe, effective, and clinically appropriate transition plan for the member
• Assists with managing member's discharge plans to ensure a timely and smooth discharge between levels of care and facilities
• Collects, documents, and maintains all discharge plans taken on member medical records in health management systems according to utilization management policies and guidelines
• Assists with providing education to members and their families on discharge plan and utilization processes to ensure high quality appropriate care to members, as applicable
• Provides feedback to leadership on opportunities to improve the discharge planning process for members to ensure high-quality transitional care
• Coordinates and assists with completion of prior authorizations as they related to discharge planning, as applicable
• Assists concurrent review team as needed
• Performs other duties as assigned
• Complies with all policies and standards

Education/Experience

Requires Graduate from an Accredited School of Nursing or Bachelor's degree in Nursing and 2 – 4 years of related experience. 2+ years of acute care experience required. Clinical knowledge of discharge planning competencies preferred. Knowledge of Medicare and Medicaid regulations preferred. Knowledge of utilization management processes preferred.

License/Certification

• LPN - Licensed Practical Nurse - State Licensure required
• RN - Registered Nurse - State Licensure and/or Compact State Licensure

Pay Range: $27.02 - $48.55 per hour