Discharge Planner/Social Worker

Job Summary:

The Discharge Planner coordinates all aspects of discharge planning for short-term rehab patients.

Essential Job Functions:

• Initiates, sets up, and coordinates a discharge planning meeting with all transitional rehab patients and/or their representative within 72 hours of admission.
• Initiates, sets up, and coordinates all aspects of Home Health, Durable Medical Equipment, and any other in-home services for transitional rehab patients in preparation for a safe discharge home.
• Establishes his/herself as the primary contact for discharge planning for transitional rehab patients and their families.
• Completes and is responsible for all social work MDS requirements for transitional rehab patients.
• Assists patients and families with alternate discharge plans to include Medicaid, assisted living or skilled nursing placement.
• Issues and ensures delivery of the notice of Medicare Non-Coverage for all Medicare Part A patients or an equivalent replacement.
• Sends, coordinates, and gathers all information for insurance and Medicare replacement plans to ensure timely payment and minimum requirements.
• Attends all regular meetings including but not limited to the morning 48-hour meeting, care plans, discharge planning, and weekly Medicare meetings.
• Maintains appropriate communication with all disciplines regarding discharge including discharge emails, phone calls, etc.
• Ensures appropriate and accurate medication scripts for transitional rehab patients upon discharge.
• Promotes and supports the Salemtowne Shines culture and philosophy.
• Completes annual compliance and HIPAA training and exhibits behavior as set forth by the Code of Compliance in the performance of their duties.
• Adheres to Salemtowne’s policies and procedures regarding the compliance program of the organization and is timely in reporting any possible concerns.
• Follows all local, state, and federal regulations as they pertain to their position.
• Adheres to the Salemtowne’s policies and procedures covering privacy and security in compliance with HIPAA regulations.
• Performs other duties as assigned.

Required Skills/Abilities:

• Ability to model and ensures that others are providing care in a manner that honors elders’ preferences and individuality.

• Capable of seeing leadership of others as a role of service, rather than one of authority, and seeks to support and under gird other’s ability to succeed. Willing to do any tasks needed, including those that may seem menial or unpleasant.
• Ability to recognize early signs of changing conditions and uses all available and appropriate resources to resolve needs. Very strong observational and assessment skills with regards to physical/social/spiritual conditions, coupled with ability to discern effective response / treatment. Able to embrace uncommon methods if they will best suit elders’ needs.
• Sensitive to changing medical needs and the nature of staff responses and takes appropriate actions regardless of whether the needs have been reported by others.
• Ability to model person-centered practices and provide direction to other team members as needed.
• Capable of facilitating a sense of team connection and participation. Able to nurture sense of accountability to elders and household among nursing staff. Able to advocate for needs of either household, elders, family, or staff as needed.
• Skilled at mediating conflicts concerning team members as needed.
• Ability to provide clear directions, expectations, and feedback. Able to elicit trust and cooperation from team members. Able to communicate elders’ medical needs clearly with team members, resident representatives, and others that have a need to know.
• Exhibits a strong positive attitude toward customer service.

Education and Experience:

• Bachelor of Science degree in marketing or healthcare related field.
• Three (3) to five (5) years’ experience in a related admissions or business development position, preferably in a healthcare setting.

Physical Requirements:

• Capable of standing and walking short distances for extended periods of time.
• Ability to lift, carry, push and/or pull objects more than 50 pounds.
• Stoop and bend at the knees, twisting from side to side at the waist.
• Reach above, below, and at shoulder level.

Work Environment:

Works in a clean, well-lighted facility. Possible work hazards include bloodborne pathogens, moving parts, muscular pains, and strong offensive odors.

All requirements are subject to possible modification to reasonably accommodate individuals with disabilities.

This job description in no way states or implies that these are the only duties to be performed by the associate occupying this position. Associates will be required to follow any other job-related instructions and to perform other job-related duties requested by their supervisor.

Requirements are representative of minimum levels of knowledge, skills and/or abilities. To perform this job successfully, the incumbent will possess the abilities or aptitudes to perform each duty proficiently.

This document does not create an employment contract, implied or otherwise, other than an “at-will” employment relationship.