Discharge Planner
工作简介时间及地点：全职时间：周一-星期五 EST 全程远程位置协调医院医生团队医疗师计划和医院医院医护人员项目内的住院患者的治疗转型活动。评估退院需求，与医生，护士，案例管理者，病人，家庭和社区提供商合作，并促进安全及及时从医院转移的适当后急性服务。通过协调服务，教育患者和照顾者，解决退院障碍以及确保遵守监管和组织要求来支持持续的护理。医院专家 I,医疗师 - MPG 在既定政策，基于证据的实践和跨学科护理过程下开展专业临床工作。在协调常规和中度复杂的退院计划方面练习临床判断，根据情况升级更高风险的情况和复杂的心理社会或医学问题。工作主要影响到个人的患者结果，护理转型和运营效率。你将如何产生影响 & 要求关键责任 • 通过审查医疗记录，跨学科合作，接受患者采访以及对治疗退院后影响的临床，功能性，心理社会和环境因素的评估来评估病人放假计划需求。• 制定并协调与医生命令，患者目标，付款人要求和可用的社区资源一致的个别放假计划。• 与医院医师，护理人员，病例管理员，治疗师，药剂师，社会工作者和辅助部门合作，以协调及时，安全和有效的患者放假。• 根据情况，安排家庭卫生，熟练护理设施，康复服务，耐用医疗设备，托管中心，外院治疗，交通和社区资源等急症后的服务。• 培养患者和照顾者关于退休说明，药物，随访日期，疾病管理，需要医疗保健的警告标志以及可用的社区资源。• 确定退学障碍，包括保险授权延迟，运输需求，照顾者的限制，设备的可用性，住房问题或健康社会因素，并协调适当的干预措施。•与初级医疗保健提供者沟通，
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Job Description Summary
Hours & Location:
Full Time: Monday-Friday EST
Fully Remote position
Coordinates discharge planning and care transition activities for hospitalized patients within the Millennium Physician Group Hospitalist program. Assesses discharge needs, collaborates with physicians, nurses, case managers, patients, families, and community providers, and facilitates appropriate post-acute services to promote safe, timely transitions from the hospital. Supports continuity of care by coordinating services, educating patients and caregivers, addressing barriers to discharge, and ensuring compliance with regulatory and organizational requirements.
The Discharge Planner I, Hospitalists - MPG performs professional clinical work under established policies, evidence-based practices, and interdisciplinary care processes. Exercises clinical judgment in coordinating routine and moderately complex discharge plans, escalating higher-risk situations and complex psychosocial or medical issues as appropriate. Work primarily impacts individual patient outcomes, care transitions, and operational efficiency.
How will you make an impact & Requirements
Key Responsibilities
• Assess patients' discharge planning needs through review of medical records, interdisciplinary collaboration, patient interviews, and evaluation of clinical, functional, psychosocial, and environmental factors affecting post-discharge care.
• Develop and coordinate individualized discharge plans that align with physician orders, patient goals, payer requirements, and available community resources.
• Collaborate with hospitalists, nursing staff, case managers, therapists, pharmacists, social workers, and ancillary departments to coordinate timely, safe, and effective patient discharges.
• Arrange post-acute services including home health, skilled nursing facilities, rehabilitation services, durable medical equipment, hospice, outpatient therapies, transportation, and community-based resources as appropriate.
• Educate patients and caregivers regarding discharge instructions, medications, follow-up appointments, disease management, warning signs requiring medical attention, and available community resources.
• Identify barriers to discharge including insurance authorization delays, transportation needs, caregiver limitations, equipment availability, housing concerns, or social determinants of health, and coordinate appropriate interventions.
• Communicate with primary care providers, specialists, post-acute providers, payers, and external agencies to facilitate continuity of care and reduce avoidable readmissions.
• Document discharge planning assessments, care coordination activities, referrals, patient education, and transition plans accurately within the electronic health record in accordance with organizational standards and regulatory requirements.
• Monitor discharge timelines, transition metrics, and assigned patient caseloads while supporting organizational goals related to length of stay, readmission reduction, patient satisfaction, and quality outcomes.
• Participate in interdisciplinary rounds, quality improvement initiatives, patient safety activities, and care transition programs that improve discharge processes and patient outcomes.
Benefits:
- 3 weeks PTO & 8 paid holidays
- Medical, Dental, Vision
- Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)
- 401(k) with match
- Employee Wellness
- Other Employee Discount programs like Tickets at Work and cell phone discounts
- Other benefits: Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and more
Why Millennium?
Millennium Physician Group is one of the largest comprehensive primary care practices with healthcare providers throughout Florida.
At Millennium Physician Group, you will find an organization that focuses on family and building a strong network of people to care for the communities we serve. We are always searching for employees who have a strong customer service attitude, fantastic teamwork skills and a willing smile ready to share.
Our promise is to provide you with the tools to do your job successfully, as well as providing a team atmosphere that empowers you to seek better ways to deliver care to our patients and their families. We also promise to care for you as an individual, and help you grow in your role with Millennium Physician Group.
If you are interested in joining an organization that puts an emphasis on team work and family, then Millennium Physician Group is the right choice.
• Maintain knowledge of applicable regulatory requirements, Medicare Conditions of Participation, payer guidelines, post-acute care resources, and evidence-based transition-of-care practices.
Compensation Range:
$52,877.00to
$79,316.00The anticipated base salary range represents the Company's good-faith estimate of the compensation it reasonably expects to pay for this position at the time of posting. Actual compensation will be determined based on factors including experience, skills, qualifications, geographic location, internal equity, and business needs.
Originally posted on Himalayas