JOIN OUR TEAM AT UPMC HAMOT AS A FULL-TIME DISCHARGE PLANNING ASSOCIATE

At UPMC Hamot, we are dedicated to providing compassionate, high-quality care to our patients. As a Discharge Planning Associate, you will play a key role in ensuring patients receive the appropriate support and resources throughout their care journey. Working alongside our multidisciplinary team, you will coordinate effective discharge plans that optimize patient outcomes, satisfaction, and overall well-being. If you are passionate about making a difference in patient care and enjoy working in a collaborative environment, we invite you to apply and be part of our mission to enhance lives through exceptional healthcare.
Job Title: Full-Time Discharge Planning Associate
Location: UPMC Hamot
Shift: 5 days, 8-hour shifts (7:30 AM - 4:00 PM) or 4 days, 10-hour shifts (7:30 AM - 6:00 PM)

JOB DESCRIPTION:

In collaboration with the Discharge Planning team, the Discharge Planning Associate is responsible for coordinating appropriate support services and resources across UPMC to facilitate effective discharge plans that optimize patient satisfaction, clinical outcomes, and financial outcomes throughout the continuum of care.

Responsibilities:

• Patient Assessment:
• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process, ensuring the patient’s goals are prioritized for optimal outcomes.
• Assess the patient’s/family’s/caregiver’s level of health literacy, understanding, and engagement with the discharge process.
• Evaluate the impact of social determinants of health, adjusting plans to reduce the risk of poor transitions.
• Comprehensive Evaluation:
• Complete detailed assessments for all patients to understand medical and social factors, assess self-care capacity, identify support systems, and recognize barriers to discharge.
• Continually reassess discharge plans to ensure they meet evolving care needs and reflect changes in patient status.
• Discharge Plan Coordination:
• Facilitate interdisciplinary team efforts to ensure safe, efficient discharges.
• Maintain up-to-date knowledge of local resources, service providers, and post-hospital care options.
• Collaborate with care teams to make appropriate post-hospital care arrangements, minimizing discharge delays.
• Collaboration & Communication:
• Engage in clear, open communication with patients, families, caregivers, and the care team to develop and execute discharge plans.
• Serve as a liaison between patients and the care team, coordinating an individualized plan of care based on patient needs, goals, and available resources.
• Integrate clinical recommendations, test results, and outstanding orders into the discharge plan, adjusting as necessary.
• Post-Hospital Transition:
• Act as the point of contact between hospitals, post-hospital care facilities, and physicians to ensure continuity of care.
• Collaborate with attending physicians, caregivers, and multidisciplinary teams to create and maintain an appropriate discharge plan.
• Patient Advocacy & Risk Management:
• Advocate for patients and families to ensure access to necessary services and protect the patient’s health, safety, well-being, and rights.
• Manage care costs while ensuring patient safety, clinical quality, and satisfaction.
• Professional Development & Team Support:
• Embrace and incorporate innovation and technology to improve patient care and outcomes.
• Provide mentoring and orientation to staff as needed, fostering collaboration and professional growth.
• Compliance & Standards:
• Ensure adherence to ethical standards, codes of conduct, and regulatory requirements.
• Align with UPMC’s mission, vision, and values in all discharge planning activities.
• Maintain clinical knowledge and compliance with relevant regulations.

If you have any questions about the position or would like to discuss the role in more detail, please don’t hesitate to reach out. Our recruiter is available to assist you and provide more information to help you determine if this opportunity is the right fit for you.
To connect, simply send an email to valencickp@upmc.edu, and we’ll be happy to schedule a time to speak with you or address any inquiries you may have.

Education:

• Diploma or Associate’s Degree in Nursing, OR
• Bachelor’s degree in Social Work or another health or human services field that promotes the physical, psychosocial, and/or vocational well-being of individuals. No license required.

Experience:

• No prior experience in discharge planning or care coordination required.
• Clinical or patient-facing experience is preferred.

Knowledge and Skills:

• Excellent communication skills, both verbal and written.
• Strong planning, organizational, follow-up, and problem-solving skills.
• Ability to think critically and apply logical principles to a wide range of situations.
• Comfortable working independently and collaborating as part of a team.
• Proficient in using computer systems and software.

Licensure, Certifications, and Clearances:

• Registered Nurses employed in this position are required to maintain an active RN license.

• Patient Assessment:
• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process, ensuring the patient’s goals are prioritized for optimal outcomes.
• Assess the patient’s/family’s/caregiver’s level of health literacy, understanding, and engagement with the discharge process.
• Evaluate the impact of social determinants of health, adjusting plans to reduce the risk of poor transitions.
• Comprehensive Evaluation:
• Complete detailed assessments for all patients to understand medical and social factors, assess self-care capacity, identify support systems, and recognize barriers to discharge.
• Continually reassess discharge plans to ensure they meet evolving care needs and reflect changes in patient status.
• Discharge Plan Coordination:
• Facilitate interdisciplinary team efforts to ensure safe, efficient discharges.
• Maintain up-to-date knowledge of local resources, service providers, and post-hospital care options.
• Collaborate with care teams to make appropriate post-hospital care arrangements, minimizing discharge delays.
• Collaboration & Communication:
• Engage in clear, open communication with patients, families, caregivers, and the care team to develop and execute discharge plans.
• Serve as a liaison between patients and the care team, coordinating an individualized plan of care based on patient needs, goals, and available resources.
• Integrate clinical recommendations, test results, and outstanding orders into the discharge plan, adjusting as necessary.
• Post-Hospital Transition:
• Act as the point of contact between hospitals, post-hospital care facilities, and physicians to ensure continuity of care.
• Collaborate with attending physicians, caregivers, and multidisciplinary teams to create and maintain an appropriate discharge plan.
• Patient Advocacy & Risk Management:
• Advocate for patients and families to ensure access to necessary services and protect the patient’s health, safety, well-being, and rights.
• Manage care costs while ensuring patient safety, clinical quality, and satisfaction.
• Professional Development & Team Support:
• Embrace and incorporate innovation and technology to improve patient care and outcomes.
• Provide mentoring and orientation to staff as needed, fostering collaboration and professional growth.
• Compliance & Standards:
• Ensure adherence to ethical standards, codes of conduct, and regulatory requirements.
• Align with UPMC’s mission, vision, and values in all discharge planning activities.
• Maintain clinical knowledge and compliance with relevant regulations