Regional Discharge Planner

Job Summary:

Actively assist facility social services staff with transitioning residents to an appropriate lower level of care or permanent long-term care, after they complete their short term skilled rehabilitation program.

*A regional discharge planning coordinator plays a crucial role in ensuring that patients are well-prepared to leave the hospital after receiving treatment. 

Key Responsibilities:

1. Post-Discharge Plans and Arrangements: Work closely with doctors, nurses, social workers, and other healthcare professionals to ensure that patients understand their post-discharge plans. This includes arrangements for continuing care, such as home health services or physical therapy.

2. Insurance Coordination: Coordinate with insurance companies to ensure that bills are paid and claims are processed promptly.

3. Patient Safety and Comfort: Before discharge, ensure that the patient’s living environment is safe and comfortable.

4. Family and Caregiver Coordination: Coordinate with family members or other caregivers to ensure that they can meet the patient’s needs after discharge.

5. Transfer Management: If necessary, facilitate patient transfers between hospitals or other facilities.

6. Healthcare Team Communication: Communicate with physicians, nurses, social workers, and other members of the healthcare team regarding patient progress.

7. Discharge Instructions: Prepare clear discharge instructions for patients, ensuring they understand their medications and follow home care guidelines.

Qualifications:

5 years skilled nursing facility Discharge Planning experience or Social Services Certified

Knowledge of CAL AIM Community Support Programs and application process.

Knowledge of State, County, City homeless community programs.

Knowledge of community support programs, home care, home health, meals on wheels, adult day programs, etc.

Travel:

Must be able to travel to Northern California as needed.