Shift : Days 5x8 830a-500p or 4x10 700a-500p with weekends
- Manages all aspects of discharge planning for assigned patients.- Implements discharge planning timely and provides resources in an efficient manner.
- Meets with patient / family to assess needs and develop an individualized discharge plan in collaboration with physicians.
- Identifies and documents barriers for timely disposition.- Ensures / maintains discharge plan consensus with patient / family, physicians, care teams and payers.
- Responds to referrals for patient's post-acute needs from physicians and the care team.- Participates in Interdisciplinary Rounds with the patient's care team to confirm estimated date of discharge and make recommendations for best level of care transition at discharge.
- Initiates / facilitates post-acute referrals through departmental processes for timely transition to the next level of care.
- Refer appropriate cases for social work intervention based on departmental protocol.- Allows for any cultural or religious beliefs in providing service and continuity of care.
Documentation- Initial clinical / psychosocial assessment completed and documented in medical record.- Ensure all records are up-to-date and documentation is clear and concise.
- Ensure timely and accurate documentation in progress notes of interactions with patient / family, physicians, care team, and community partners as it pertains to the patient's discharge plan.
- Accounts for and indicates all services arranged / delivered in electronic medical record.- Track avoidable days and report trends that lead to undesired outcomes.
Professional Development and Initiative- Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
Supports department-based goals which contribute to the success of the organization.- Serves as a preceptor and / or mentor for student interns (if appropriate)
Required Minimum Education :
Associate's Degree in Nursing from an accredited school of nursing with a Georgia RN License Required
Shift : Days
Days
Additional note : Shift : Days 5x8 830a-500p or 4x10 700a-500p with weekends
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