Resp & Qualifications
The Discharge Planner RN is supporting the CareFirst Maryland Medicaid Program
Position Summary: Coordinates and facilitates patient discharge planning in collaboration with other health care professionals during hospitalization, ED visits and/or post-acute admissions. Assist with organizing services across provider lines, between people and systems, to affect optimal patient outcomes, achieve continuity of care and reduce costs. Serve as an organization resource to determine appropriateness of needed follow up care. Position may be on site, remote, or in office, dependent on facility.
Essential Duties and Responsibilities:
- Promote the mission, vision, and values of the organization.
- Identifies health plan members for teaching, discharge, home care and other post-acute needs.
- Collaborates with physicians, caregivers, patient, family, other departmental team members, and health plan to proactively develop and implement a safe and appropriate discharge plan.
- Participates in team meetings that foster interdepartmental collaboration with the member and their family as deemed necessary.
- Maintains working knowledge of Medicare and Medicaid coverage for referred products and services.
- Communicates regularly with admissions personnel regarding admissions and discharges to various facilities.
- Identifies member’s diagnosis and discharge needs, subsequently documenting and tracking each inpatient member as an ongoing review.
- Knowledgeable of inpatient admission status vs observation.
- Monitors hospital and ED utilization.
- Maintains a current list of resources and refers member to the appropriate inpatient, outpatient, and community resources.
- Must maintain accurate daily and monthly reports related to assigned facilities for statistical trends.
- Appropriate hand-off of member to the Transitional Care Coordination team when discharged.
- Serve as company liaison/ spokesperson for Case Management.
Education, Experience and Qualifications:
- A current Maryland nursing license without restrictions required
- 3-5 years of clinical nursing experience in medical-surgical, community/home health care, or equivalent experience reviewing patient medical care and services in one or more of the following specialty fields:
- High risk diseases and comorbidities (e.g. diabetes, hypertension, COPD, CHF, asthma)
- Complex Medical Illnesses (e.g. HIV/AIDS, ESRD, Oncology)
- Palliative Care/Hospice
- 1-3 years of nursing experience in case management, discharge planning, care coordination or acute care
- In-depth knowledge of current standards of medical practice and insurance benefit structures to facilitate medical review decisions and interpret contract benefits and managed care guidelines
- Detailed knowledge and competency in all types of medical necessity decisions, including inpatient care, subacute/skilled care, outpatient care, hospice care, and home health care
- Health Plan experience is a plus
- BSN preferred
Knowledge, Skills and Abilities:
- Exceptional professionalism and strong communication skills, both written and oral, with the commitment to treat others with respect and compassion
- Strong, autonomous work ethic built on a foundation of proactivity and teamwork.
- Ability to alternate site schedule based on census and acuity.
- Ability to navigate ambiguity with the aid of structured problem-solving techniques.
- Committed to the practice of inquiry and listening.
- Willingness to travel locally.
- Fluency in a foreign language is a plus.
- Substantial knowledge of Microsoft Office including SharePoint, Outlook, Excel and Word, PowerPoint
- Proficiency in medical management software utilized for utilization review, medical appeals, and case management preferred
- Proficiency in electronic health record systems
- This position requires travel to assigned facilities and other health care facilities as deemed necessary, at least 2-3 times per week, depending on member census.
- Must have reliable transportation.
Equal Employment Opportunity
CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.
Hire Range Disclaimer
Actual salary will be based on relevant job experience and work history.
Where To Apply
Please visit our website to apply: www.carefirst.com/careers
Please apply before: 12/16/2020
Federal Disc/Physical Demand
Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.
The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted.
Sponsorship in US
Must be eligible to work in the U.S. without Sponsorship