Join a team where your expertise makes a direct impact on patient outcomes every day!
UPMC St. Margaret is seeking a Discharge Plan Manager to help patients navigate safe, successful transitions from the hospital to their next level of care. As part of our collaborative Care Management team, you'll work closely with nurses, providers, therapists, dietitians, and community partners to develop individualized discharge plans that support the best possible patient outcomes.
What makes this opportunity unique?
- Tight-knit, supportive team culture with a collaborative approach to patient care
- Active participation in Multidisciplinary Rounds (MDRs), helping drive communication and coordinated care planning
- Monday through Friday scheduling with flexible 8- or 10-hour shift options (7:00 AM to 3:30 PM or 7:00 AM to 5:30 PM)
- Opportunity to advance through UPMC's career ladder and grow your professional impact
- Meaningful work that directly influences patient experiences both during hospitalization and after discharge
We're looking for passionate care management professionals who thrive in a team environment and are committed to delivering exceptional patient-centered care.
Make a difference beyond the bedside. Apply today and help shape the patient journey from admission through discharge!
The Discharge Plan Manager is a valued step in the UPMC career ladder, with opportunities for continued growth and advancement. Title and salary will be determined based upon education and nursing experience.
Responsibilities:
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.
Provide staff orientation and mentoring as appropriate.
*Performs in accordance with system-wide competencies/behaviors.
*Performs other duties as assigned.
1) Diploma or associate degree in nursing and active Registered Nurse license. At least one year of experience in discharge planning/care coordination required.
OR
2) Bachelor's degree in social work or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of those being served required. Master's degree preferred. At least one year of experience in discharge planning/care coordination required.
KNOWLEDGE AND SKILLS:
Must possess knowledge in navigating communications with payer sources and programs.
Possess knowledge and understanding of regulatory guidelines.
Must be skilled in planning/organization, follow up/control, delegation. Problem solving, self-development, organizational behaviors/competencies.
Must be able to read, understand, analyze, and interpret medical record documents.
Must possess the ability to apply principles of logic and critical thinking to a wide range of problems and to deal with a variety of abstract and concrete variables.
Demonstrate ability to function independently, taking initiative to be proactive and drive a discharge plan while working with a multi-disciplinary team.
Be able to lead care teams to develop and execute safe and efficient discharge plans.
Maintain knowledge about area resources and their capabilities and capacities as well as various types of service providers available.
Demonstrate understanding of inpatient care setting operations.
Ability to manage multiple priorities in a fast-paced environment.
Licensure, Certifications, and Clearances:
Registered Nurses employed in this position are required to maintain active RN license. OR Those without an active RN license, an LSW/LCSW or education-appropriate license required. CCM/ACM or other nursing or social work certification preferred.
- Licensed Clinical Social Worker (LCSW) OR Licensed Social Worker (LSW) OR Other Healthcare Professional Licenses for Discharge Planning OR Registered Nurse (RN)
- Act 33 with renewal
- Act 34 with renewal
- Act 73 FBI Clearance with renewal
*Current licensure either in the state where the facility is located or, if the facility is in a state covered by the multistate Nursing Licensure Compact (NLC) agreement, a multistate license issued by a participating NLC state. Hires and current employees working on an out-of-state NLC license who later change their residency to the state where the facility is also located will have 60 days upon changing their residency to apply for licensure within that state.
UPMC is an Equal Opportunity Employer/Disability/Veteran