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Hospital Discharge Planning Jobs in Indiana (NOW HIRING)

Majestic Care of Avon

Marketing Director

Avon, IN

Respond to inquiry calls from hospital discharge planners, families, and other referral sources. * Conduct community tours. * Manage the admission process by maintaining updated bed availability and ...

Majestic Care

Marketing Director

Avon, IN · On-site

Respond to inquiry calls from hospital discharge planners, families, and other referral sources. * Conduct community tours. * Manage the admission process by maintaining updated bed availability and ...

RIVERVIEW HOSPITAL

Clinical Case Mgr

Noblesville, IN

Compare hospital medical records to established care guidelines and communicates with various ... Coordinate delivery of regulatory documents and may communicate with a discharge planner as needed ...

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Hospital Discharge Planning information

What are the key skills and qualifications needed to thrive as a hospital discharge planner, and why are they important?

To thrive as a Hospital Discharge Planner, you need a background in nursing, social work, or case management, often supported by a relevant degree and licensure such as RN or LCSW. Familiarity with electronic health records (EHRs), discharge planning software, and knowledge of insurance and community resources are typically required. Strong communication, problem-solving, and organizational skills help facilitate collaboration among patients, families, and healthcare teams. These skills ensure safe, efficient patient transitions, reduce readmissions, and improve overall care outcomes.

What are some common challenges faced by hospital discharge planners, and how can they be addressed?

Hospital discharge planners often encounter challenges such as coordinating care among multiple healthcare providers, addressing patients’ diverse social and medical needs, and ensuring clear communication with families. These challenges can be managed by maintaining up-to-date knowledge of community resources, fostering strong interdisciplinary collaboration, and using standardized discharge protocols. Developing strong organizational and communication skills is also crucial for addressing potential barriers and ensuring safe, timely transitions for patients.

What is hospital discharge planning?

Hospital discharge planning is a process used by healthcare professionals to ensure that patients leaving the hospital receive the care and support they need after discharge. It involves assessing the patient's ongoing medical needs, arranging follow-up appointments, coordinating home care or rehabilitation services, and providing instructions for medications and self-care. Effective discharge planning helps prevent readmissions, promotes recovery, and supports patients and their families as they transition from hospital to home or another care facility.

What is the difference between Hospital Discharge Planning vs Hospital Social Work?

AspectHospital Discharge PlanningHospital Social Work
CredentialsTypically requires a background in healthcare, social work certification preferredRequires a social work degree and licensure
Work EnvironmentHospitals, rehab centers, post-acute care facilitiesHospitals, community clinics, social service agencies
Primary FocusCoordinating patient discharge and post-hospital careAddressing social, emotional, and environmental factors affecting health

Hospital Discharge Planning focuses on coordinating patient discharge and ensuring proper post-hospital care, while Hospital Social Work addresses broader social and emotional needs impacting patient health. Both roles collaborate closely but serve distinct functions within healthcare settings.

What are popular job titles related to Hospital Discharge Planning jobs in Indiana? For Hospital Discharge Planning jobs in Indiana, the most frequently searched job titles are:
What job categories do people searching Hospital Discharge Planning jobs in Indiana look for? The top searched job categories for Hospital Discharge Planning jobs in Indiana are:
What cities in Indiana are hiring for Hospital Discharge Planning jobs? Cities in Indiana with the most Hospital Discharge Planning job openings:
Hospital Discharge Planning jobs near you
Infographic showing various Hospital Discharge Planning job openings in Indiana as of July 2026, with employment types broken down into 3% As Needed, 71% Full Time, 20% Part Time, and 6% Contract. Highlights an 98% Physical, and 2% Remote job distribution.

Weekend Clinical Care Partner - RN, LMSW, LCSW, or LICSW licensure required

FC Compassus LLC

Indianapolis, IN • On-site

Part-time

Posted 19 days ago

Compassus rating

7.3

Company rating: 7.3 out of 10

Based on 85 frontline employees who took The Breakroom Quiz

22nd of 240 rated social care providers

Job description

Company:
Ascension at Home together with Compassus
Position Summary: The Weekend Clinical Care Partner is responsible for coordinating safe, efficient, and patient-centered transitions of care for hospitalized patients. This role evaluates patients for appropriate post-acute home-based care services and supports timely, high-quality discharge planning in collaboration with physicians, case management, patients, families, and post-acute providers.
The position focuses on improving patient outcomes, reducing length of stay and readmissions, and ensuring patients receive the right care in the right setting at the right time. This is an in-person role requiring bedside engagement, interdisciplinary collaboration, and active participation in discharge planning workflows.
Position Specific Responsibilities: RN, LMSW, LCSW, or LICSW licensure required. This is a weekend role, covering EVERY Saturday and Sunday. 8am - 6pm
Referral Evaluation & Clinical Assessment
  • Evaluate patients for appropriateness for home-based and post-acute care services based on clinical, functional, psychosocial, and environmental factors
  • Review inpatient referrals and prioritize patients using clinical judgment and predictive analytics tools
  • Collaborate with physicians and care teams to support appropriate level-of-care decisions
  • Identify patients appropriate for value-based post-acute care services

Discharge Coordination & Care Transitions
  • Coordinate and facilitate timely, safe, and appropriate hospital discharge planning
  • Develop and implement individualized transition-of-care plans aligned with patient needs and clinical goals
  • Partner with physicians, advanced practice providers, case management, and nursing teams
  • Arrange post-acute services including home health, hospice, durable medical equipment, medications, and follow-up care
  • Ensure accurate and timely patient handoff to post-acute providers

Stakeholder Education
  • Educate patients and families on post-acute care options, care expectations, and available services
  • Provide bedside education to support informed patient choice and shared decision-making
  • Educate hospital staff and clinical stakeholders on post-acute pathways and referral processes
  • Support understanding of value-based care principles and appropriate site-of-care selection

Referral Source Relationship Management
  • Serve as liaison between hospital teams and post-acute providers to support timely referrals and placements
  • Maintain strong relationships with physicians, case management, nursing teams, and discharge planners
  • Participate in interdisciplinary rounds, discharge planning meetings, and care coordination discussions
  • Strengthen referral network partnerships to improve access and placement efficiency

GIP / Hospice-Specific Coordination (if applicable to service line)
  • Identify patients appropriate for hospice and/or General Inpatient (GIP) level of care
  • Coordinate hospice evaluations, eligibility determinations, and admission processes
  • Support end-of-life transitions with clinical urgency and patient-centered communication
  • Ensure alignment with hospice eligibility requirements and physician certification processes

Documentation & Technology
  • Document all care coordination activities accurately and timely in the electronic medical record
  • Manage referrals through designated hospital and post-acute referral systems
  • Utilize clinical decision-support tools and predictive analytics platforms
  • Maintain accurate tracking of referrals, outcomes, and transitions across systems

Performance, KPIs & Strategy
  • Support VBE performance goals and care coordination strategy
  • Contribute to key performance indicators including:
    • Hospital Length of Stay (Observed-to-Expected Ratio)
    • Hospital Readmission Rates
    • Hospital Mortality Rates
    • Timely Initiation of Care
    • Referral-to-Admit Rate
    • Referral Quality and Documentation Accuracy
  • Participate in quality improvement and workflow optimization initiatives
  • Support organizational initiatives to improve post-acute network performance and patient outcomes

Education and/or Experience:
  • Certifications, Licenses, and Registrations
  • Required: Active and unencumbered RN, LMSW, LCSW, or LICSW licensure. Current CPR certification. Compliance with all JV hospital partner occupational health requirements.
  • Education
  • Required: Associate's degree in Nursing, Health Sciences, or related field. Alternatively, equivalent degree and healthcare experience.
  • Preferred: Bachelor's degree in nursing, Health Sciences, or related field.
  • Experience
  • Required: Home Health experience preferred.
  • Preferred: 2-3 years of experience in care coordination, discharge planning, or healthcare services. Hospital, home health, hospice, or post-acute care experience. Experience working with EMR systems (ie: Epic) and referral platforms.

Skills
  • Language Skills: Ability to read, analyze, and interpret clinical documentation, professional journals, technical procedures, or governmental regulations. Ability to write reports, business correspondence, and procedure manuals. Ability to effectively present information and respond to questions from leaders, teammates, patients, families, and external parties. Strong written and verbal communications.
  • Other Skills and Abilities: Ability to understand, read, write, and speak English. Articulates and embraces hospice philosophy. Ability to manage multiple projects simultaneously and meet deadlines. Ability to design accessible and inclusive learning experiences for a diverse workforce.

Physical Demands and Work Environment: The demands of this role necessitate a team member to effectively perform essential functions. Adaptations can be made to accommodate team members with disabilities. Regular standing, walking, and manual dexterity are fundamental, along with the ability to lift and move objects up to 50 pounds. Visual acuity requirements include close and distance vision, color and peripheral vision, depth perception, and the ability to adjust focus. This description provides a general overview and may vary by role and department, capturing the nuanced demands and conditions inherent to positions in our organization.
At Compassus, including all Compassus affiliates, diversity, equity, and inclusion are fundamental to our Pillars of Success. We are committed to creating a fair work environment where our team members feel welcomed, highly valued, and respected. As an equal opportunity employer, all qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status.
#LI-KM1
Build a Rewarding Career with Compassus
At Compassus, we care for our team members as much as we care for our patients and their families. Through our Care for Who I Am culture, we show compassion, respect, and appreciation for every individual. Embark on a career that cares for you while you care for others.
Your Career Journey Matters
We're dedicated to helping you grow and succeed. Whether you're pursuing leadership roles, specialized training, or exploring new career paths, we provide the tools and support you need to thrive.
The Compassus Advantage
• Meaningful Work: Make an impact every day by honoring the quality of life of our patients, supporting them and their families with compassion, and creating moments that truly matter.
• Career Development: Access leadership pathways, mentorship, and personalized professional development.
• Innovation Meets Compassion: Collaborate with a supportive team using the latest tools and technologies to deliver exceptional care.
• Enhanced Benefits: Enjoy competitive pay, flexible time off, tuition reimbursement, and wellness programs designed for your well-being.
• Recognition and Support: Be celebrated for your contributions through recognition programs that honor your dedication.
• A Culture of Belonging: Thrive in a culture where you can be your authentic self, valued for your unique contributions and supported in a community that embraces diversity and inclusion.
Ready to Join?
At Compassus, your career is more than a job-it's an opportunity to make a lasting impact. Take the next step and join a team that empowers you to grow, innovate, and thrive.

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