Millennium Physician Group
  • 02-Jan-2019 to 03-Mar-2020 (EST)
  • Naples, FL, USA
  • Salary
  • Full Time

The Discharge Planner is responsible for direct provision of Patient centered services to assist patients with the orderly transition of care from the hospital setting to the next appropriate level of care. Efforts are focused on client centered services that link clients and other family members with health care, psychosocial and other home and community based services to ensure timely, coordinated access to medically appropriate levels of health and support services and continuity of care for the transition from hospital, in-patient or short stay to the next appropriate level of care. Key components of the position include assessment, planning, coordination, advocacy, education and monitoring. Accurate documentation in all program areas is required. Must demonstrate knowledge of growth and development and possess ability to assess, interact, communicate and care for age specific patient populations.

Job Standards:

  • Assesses transition risks
  • Prepares patient through education, providing patient-centered information at discharge and assessing patient understanding of discharge plan of care
  • Develops post-discharge care plans
  • Ensures complete post-discharge follow-up including appointments, homecare/visiting nurse, transportation and provider continuity during the transition
  • Communicates and plans effectively with next stage care provider
  • Ensures post-discharge support including telephone outreach, provision of patient hotline, utilizing transition coaches, engaging community services and use of telemonitoring as required.
  • RN licensure is required
Millennium Physician Group
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