Senior Discharge Plan Manager, Casual

Are you an RN or Social Worker interested in care management, case management, or care coordination?  

UPMC Chautauqua is looking for a Senior Discharge Plan Manager to support their Clinical Care Coordination and Discharge Planning department!   This casual position has a WEEKEND schedule.

UPMC is proud to announce the NEW Clinical Care Coordination and Discharge Planning Career Ladder, dedicated to caring for patients throughout their UPMC treatment journey.

In this new model, roles are reimagined to deliver the best care and personalized experiences for our patients. RNs and Social Workers function equally in discharge planning roles!

***The Senior Discharge Plan Manager is a valued step in the Discharge Planning Career Ladder. The final candidate will be placed in the appropriate title and salary based on experience and education.

• →Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process with the patient to attain optimal outcomes. Take patient/family/caregiver level of health literacy into consideration. Evaluate patient/family/caregiver level of understanding and engagement with the progress toward goals and incorporate findings into the plan of care. Balances resources with patient preferences and goals of care. Evaluate the potential impact of social determinants of health that may elevate the risk of a poor transition.
• →Complete detailed assessment on every patient in order to establish understanding of medical and social factors, determine patient's capacity for self-care, identify support systems, outline barriers to discharge, and determine likeliness of requiring post-hospital services and the availability of such services. Continually reassess discharge plan for factors that may affect continuing care needs or the appropriateness of the discharge plan.
• →Facilitate teams to develop and execute safe and efficient discharges. Maintain knowledge about area resources and their capabilities and capacities as well as various types of service providers available. Ensure appropriate arrangements for post-hospital care will be made before discharge and work to avoid unnecessary delays in discharge. Integrate patients' goals, the health care team's assessment, risks and available resources in order to develop and coordinate a successful transition plan.
• →Engage in clear communication with the patient/member/caregivers as well as the interdisciplinary care team in order to develop discharge plans. Serve as a liaison between the patient and the care team. Actively collaborate with the attending practitioner, caregivers, and other members of the multidisciplinary team to coordinate an individualized plan of care. Incorporate discipline-specific recommendations, test results, outstanding orders into discharge plan and monitor/revise and respond to the progression of discharge milestone.
• →Serve as a contact between hospitals and post-hospital care facilities as well as the physicians who provide care in either or both of these settings.
• →Recognize and demonstrate shared accountability in development of a discharge plan with the patient/member/caregiver as well as with team members to ensure optimal outcomes.
• →Align practice with the mission, vision, and values of the organization. Adheres to ethical standards and codes of conduct of applicable professional organization and UPMC. Maintain clinical knowledge of and ensures compliance with regulatory requirements.
• →Advocate on behalf of patient/family/caregivers for services access and for the protection of the patient's health, well-being, safety, and rights.
• →Manage cost of care with the benefits of patient safety, clinical quality, risk and patient satisfaction to provide recommendations and decisions that ensure optimal outcomes.
• →Embrace and incorporate innovation and technology to improve collaboration and patient outcomes. Document care in patient medical chart.
• →Assist in operational activities for the department including staff orientation, mentoring, and other issues.
• →Demonstrate expertise in relevant content area.
• →Participate in process improvement initiatives.

1) BSN and RN license required. At least three years experience in discharge planning/care coordination. 10 years of experience can be substituted for BSN completion. OR

2) MSW or master's degree in another health and human services field that promotes the physical, psychosocial, and/or vocational well-being of those being served required. 3 years of experience in discharge planning/care coordination. 10 years of experience can be substituted for MSW completion.