The Discharge Planner has knowledge of community resources to meet post-discharge clinical and social needs.The Discharge Planner implements discharge planning referrals in collaboration with the treatment team. The Discharge Planner promotes safe and timely discharges following standardized processes and decision trees for referrals to community clinical and social resources. The Discharge planner actively engages the patient or the patient's representative in the development of the discharge plan.
- Actively collaborates with case manager, social workers and discharge planners to facilitate a timely and accurate response to the discharge planning referrals. Facilitates communication to ensure that the patient post acute care needs are coordinated
- Follows standardized processes and decision trees for referrals for ordered post acute care needs including but not limited to DME, home health SNF, subacute, LTACH
- Referrals are timely and accurate and are per contracts, contracted venders and deprtment processes using standard work and decision trees and vender data base.
- Serves as an informational resource for post acute care contracts, vendor contracts and acceptance criteria. Maintains and updates data bases so the information is easily found by others.
- Documentation in the medical record, WQ and data base is per timeliness requirement, provides the information required and is updated as changes occur
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