Discharge Planner Jobs (NOW HIRING)

Job Title: Discharge Planner

Location: 1551 CALLE ALDA URB. CARIBE,SAN JUAN, PR, USA, 00926

Duration: Contract - 6-months

$15 to $19/hr on w2

Description:

The use of this job is limited to the MMM business unit. If you believe this to be the best match for your position, please consult with your Human Resources partner prior to using this job (HRBP should work with Compensation). Acts as a liaison and triage between the inpatient and outpatient care to ensure timely movement of patients through the continuum of care and provide coordination of care. Primary duties may include but are not limited to: Provide appropriate and timely hospital discharge planning; coordinate arrangements for health care follow-up and resources available for patients. Develop referrals and coordinate services for appropriate community resources as needed. Reviews daily members census to identify potential members for discharge. Obtains member referrals from Concurrent Review Nurses identified as high risk. For members that qualify, the DP reviews the members record, contacts the concurrent review nurse and/or PCP to know actual health status and discharge date. Conducts a telephonic health assessment with member, facility discharge planner, caregiver, and physician, to identify member’s needs. Initiates a discharge plan on each qualified inpatient member within forty-eight (48) hours of admission. Incorporates member and family preferences, and strengths into a collaborative plan of care. Authorizes and/or facilitates access to specialist and therapies. . Advocates, informs, and educates beneficiaries on services and benefits. Develops and updates individualized care plan for beneficiaries. Coordinates care across settings and providers. Identifies and facilitates access to community resources and social services. Conducts risk assessment. Facilitates the implementation of the individualized care plan for each beneficiary. Request consultation and diagnostic reports from network specialists. Conduct performance assessment. Conducts medication reviews. Provides education, acts as an advocate and facilitates access to needed services and resources. For services requiring authorizations, responsible to obtain in advance required forms with required signatures and necessary information. Be aware ware of the medical necessity criteria, as well as Medicare Regulations and other established clinical guidelines, to make a coverage determination and coordinate care. Responsible for processing authorizations for the identified services as per authorization policies and procedures. In collaboration with the hospital discharge planner, the DP will coordinate approved services in advance. Will participate and be responsible to discuss qualified cases in the case rounds with the multidisciplinary team to assure adequate and appropriate member’s care. Monitors, modifies, and updates the discharge plan to assure a timely discharge between all levels of care. Close case once the plan is complete and establish adequate case disposition. Conducts On-Call to assure that members and providers have access to Health Plan licensed clinical staff 24 hours per day seven days a week. To provide coverage for review of admissions discharge planning during after-hours, weekends, and holidays. To proactively manage discharges, continued stays and facilitate transfers to the most appropriate setting for continuity of care. Requires BS in Nursing or Master Degree in Social Worker. Current Puerto Rico RN or SW license. 3 to 5 five years in clinical experience in an acute care setting, home care or discharge planning preferred. Bi-lingual (English/Spanish) required. For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Registered Nurse (RN) with experience in case management, care coordination, and population health management.
Strong skills in patient outreach, care coordination, transitional care, and chronic condition management. Ability to conduct telephonic assessments, provide patient education, and support individualized care

Experience supporting quality improvement initiatives, including HEDIS measures, reduction of emergency room utilization, and overall healthcare utilization management.
Familiarity with EMR systems and clinical documentation required. Bilingual (English/Spanish) preferred. Strong communication, critical thinking, and organizational skills required.

What is your anticipated work schedule for this job posting?

Monday–Friday, 8:00 AM – 5:00 PM. hybrid schedule with remote work and on-site presence in San juan at least 3 days per week or as required to support care coordination, patient outreach, and population health iniciatives.