Discharge Planner

Care Coordinator

Initiate referrals for subacute, acute, psychiatric, homecare, and DME to identified providers. Print, copy, and fax documentation and files. Obtain authorizations when appropriate. Coordinate transportation for patients and being the point of contact. Communicate with various providers, facilities, and the patients' families to obtain information about patients' previous placements (ie: long-term care facility) and plan of care upon their discharge. Provide timely and accurate updates to staff regarding Medicaid or other insurance details that could impact the patient's care. Call physician offices to schedule follow-up appointments, documenting in the EMR, endorse to Care Coordination Nurse and inform the patient when instructed. Contact community resources, such as homeless shelters and drug treatment programs to determine bed availability. Be a key resource for the Care Coordination Team.