Discharge Plan Manager (RN or Social Worker) UPMC Presbyterian and UPMC Shadyside

Are you an RN or social worker interested in care management, case management, or care coordination?

UPMC Presbyterian Shadyside is looking for a Discharge Plan Manager to support their Clinical Care Coordination and Discharge Planning department!

UPMC is proud to announce the new Clinical Care Coordination and Discharge Planning team, dedicated to caring for patients throughout their UPMC treatment journey.

In this new model, roles are reimagined and expertise is combined to deliver the best care and personalized experiences for our patients. RNs and social workers function equally in discharge plan roles, serving as the central point of contact through a patient's care delivery, in partnership with a Physician or APP.

Become part of a multidisciplinary team committed to improving care coordination and developing more efficient, progressive discharge planning processes, and let UPMC help you succeed through offerings that include:

• A $6,000 sign-on bonus for eligible roles with a two-year work commitment  
• A designated career ladder designed to support career advancement, with two tracks to support both nurses and social workers
• Flexible schedule options to make your career work for you
• Up to 5 ½ weeks of paid time off and 7 paid holidays
• $6,000/year in tuition assistance to help you get where you want to be
• And much more!

Responsibilities:

• Work with patients throughout their treatment journey — from day one of admission to post-discharge — to ensure patients are prepared for a successful discharge and achieve continued improvement following inpatient care.

• Advocate on behalf of patient/family/caregivers for access to services and for protecting the patient's health, well-being, safety, and rights.
• Identify clinical, psychosocial, historical, financial, cultural, and spiritual needs that guide the planning process with the patient to attain optimal outcomes.
• Complete detailed patient assessments to determine patients' capacity for self-care, identify support systems, outline barriers to discharge, and determine the likelihood that patients will require post-hospital services and the availability of those services.
• Collaborate with a multidisciplinary team to coordinate an individualized, safe, efficient care plan.
• Integrate patients' goals, the health care team's assessment, risks, and available resources to develop and coordinate a successful transition plan.
• Serve as a liaison between patients and the care team. Incorporate discipline-specific recommendations, test results, and outstanding orders into the discharge plan and respond to the progression of discharge milestones.
• Maintain knowledge of resources in the area, their capabilities and capacities, and service providers available.
• Ensure appropriate arrangements for post-hospital care will be made before discharge and work to avoid unnecessary delays in discharge.
• Serve as a contact between hospitals and post-hospital care facilities and the physicians who provide care in both settings.