Registered Nurse Discharge Planner Hr.

Qualifications: Graduate of an accredited school of professional nursing and a current license with the California State Board of Registered Nursing Ability to interact therapeutically with patients, families, physicians, co-workers and community agencies Ability to maintain confidentiality High level organizational skills Excellent communication skills Current American Heart Basic Life Support (BLS), annual update of Safety, Clinical Competency and annual Interpreter Services Demonstrate compassion and empathy with patients

Duties & 
Responsibilities: 

Job Summary

The registered nurse working in as a Discharge Planning Nurse is responsible for performing case management, utilization review, quality assurance, and discharge planning first. 

Responsibilities specific to Discharge Planning includes assessment, identification of specific needs, and social service intervention or referral while in the acute setting. Awareness of services available to patients and their families are an important part of this assessment. Determining patient needs on basis of diagnosis; prognosis and social support system/person information are included in the initial assessment process. Upon individual recognition and staff referral, the discharge planner will contact the appropriate agency to meet the patient’s social, emotional and spiritual needs.

Responsibilities specific to Utilization Review include performing admission and concurrent review, and at times retro-review of all in-patients conforming to Medicare and Medi-Cal requirements. These review processes may be applicable also to Contracted Managed Care members who are patients in the acute/ extended care units of the hospital. Issuance of non-coverage letters at time of discharge to the acute/extended care patient is also considered part of the discharge planning process as specified by contracted Health Plans and HCFA.

Responsibilities specific to Quality Assurance include performing surveillance and data collection as directed for trend recognition and development of effective actions/plans.

Duties

Demonstrates professional responsibility in the role of Discharge Planner Complies with personnel policies and hospital safety policies Maintains confidentiality when interacting with patients, families, personnel and the public Maintains compliance with State/Federal Guidelines and standards Performs duties as prescribed by the Discharge Plan of the hospital and as directed by the Assistant Director Utilization Management. Conforms to all requirements of Medicare Conforms to all requirements of Medi-Cal Keeps current on changing laws and requirements of Medicare and Medi-Cal Reports any problems to the Assistant Director Utilization Management in a timely manner Provides information in response to queries from the public, doctors’ offices, families and outside facilities Provides case management, social services, utilization review and discharge planning daily and on weekends as scheduled or assigned by the Assistant Director Utilization Management Performs morning work according to the written procedure and as directed and scheduled by the Assistant Director Utilization Management. Reviews information on Medi-Cal/CMSP patients in assigned area(s) necessary for review to Medi-Cal field office according to written procedures daily Participates in Continuing Education and other pertinent and appropriate learning experiences to maintain and increase personal and professional growth Participates in current continuing education that is relevant to the field of expertise of current practice Maintains clinical competency in the Discharge Planning /Case Mgt. /DCP field. Utilizes work time appropriately to maximize productivity Minimizes visiting with co-workers, personal telephone usage and avoids unnecessary absence from assigned work areas and tasks Utilizes work space and equipment in an appropriate, professional manner to enhance patient outcome Performs financial assessment to ascertain patients’ source of payment for in-patient stay to begin review process and obtain timely payment for services rendered by hospital Begins initial discharge planning assessment within 24 hours of admission Using scoring from initial assessment determines degree of discharge planning needed on an individual basis for each patient Completes the assessment within 72 hours of admission for each patient. Completion of assessment includes interview with the patient, family or other caregivers, and also may utilize chart information from previous stays Begins acuity assessment using Interqual criteria and standards to complete concurrent review requirements and continued acute stay as part of initial assessment Enters daily review information on computer forms to document and assess need for continued acute stay Makes additional notes and documents conversations with other members of inter-disciplinary team on computer charting forms. These notes may also include conversations with caregivers, families, and other support systems involved with the care of the patient Refers patients not currently requiring acute or skilled nursing care for discharge with appropriate services to lower level of care, or placement in appropriate facility. Preparation may include speaking with the patient, family, physicians, therapists, nurses, supervisors, intake coordinators, residential care facility managers, insurance companies, reviewers, etc. Also arranges for acute to acute transfers Physician orders and signatures on transfer sheets, financial verification, insurance approval and transfer permits will need to be obtained, and transportation arranged Checks voice mail periodically throughout the day and before leaving each day. Handles insurance review requests and patient related calls and removes the messages in a timely manner Does inpatient insurance reviews that are requested daily, utilizes the acuity assessment form and notes review outcomes, contacts and requests for further review times for follow-up Provides intervention necessary as indicated by scoring guideline of Discharge Planning assessment. This begins the case management for each patient as indicated by need identified. Case Management/DCP of the acute patient may include, but is not limited to Social Service intervention by outside agencies, such as Adult Protective Services, Child Protective Services, Psychological counseling, or follow-up by either in house MSW/ Psychologist, or County/State provided psychiatric services. Home Health referral based upon patient/ family wishes or needs. Arranging help such as IHSS, or contracted help to allow the patient to remain in their own home, ordering of DME necessary for patient recovery or convenience as ordered by the physician. Services may also include arrangement of placement in either Residential Care Facility, Assisted Living or in Skilled Nursing Facilities based upon patient/ family wishes and doctors order. Discussion of the discharge plan is ongoing from day of admission with the patient, family, interdisciplinary team, and physician staff. DCP acts as a resource person for patients referred from physician’s offices. Evaluates and refers appropriate patients to Financial Counseling or appropriate agency for assistance in obtaining Medi-Cal coverage. Contacts the appropriate agency to meet the patient’s social, emotional and spiritual needs. Provides continuity of care as the level of care changes Provides information regarding Advance Directives, assists in filling out the forms, and obtaining non-employed witnesses to complete the documentation of Advance Directives. Makes photocopies for the patient and places a copy in the chart or sends it to Medical Records for filing in the chart at any time Enters all discharges on Discharge Planning Activity Log Sheets daily for statistical purposes. Indicates on log all pertinent information regarding patient activity prior to discharge such as DME, Home Health agency referral, etc. Calls appropriate insurance companies for discharge review upon patient discharge. Makes appropriate notes to document final review given Completes retro- review to insurance companies as directed by the Assistant Director Utilization Management. Performs surveillance and data collection as directed for trend recognition and development of effective actions/plans Assist with Nursing duties as assigned per Assistant Director Utilization Management. Educate patients upon discharge using the teach back method. Performs other duties as assigned 

Organizational Expectations

Provides a positive and professional representation of the organization. Promotes culture of safety for patients and employees through proper identification, reporting, documentation, and prevention. Maintains hospital standards for a clean and quiet patient environment to maintain a positive patient care experience. Adheres to infection-control policies and protocols. Participates in ongoing quality improvement activities. Maintains compliance with organization’s policies, as well as established practices, protocols, and procedures of the position, department, and applicable professional standards. Complies with organizational and regulatory policies for handling confidential patient information. Demonstrates excellent customer service through his/her attitude and actions, consistent with the standards contained in the Vision, Mission, and Values of the organization. Adheres to professional standards, hospital policies and procedures, federal, state, and local requirements.

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