Medix is currently hiring a Registered Nurse Discharge Planner for a MLTC Plan in New York. This position will be fully remote but requires to come into the office in Manhattan 4-6 times a year. The schedule is Monday - Friday 8:30am-4:30p. We are looking for an RN with NY license that has hospital discharge planning experience.

Job Summary

Assesses member needs from the time the Management Services Organization MSO is notified of a hospital admission, skilled nursing facility admission or an observation bed stay through the discharge or transfer to the next level of care. Identifies needs and solutions in concert with the facility staff, member and caregiver to develop a high quality safe discharge plan. Works with the authorization and utilization management teams to generate timely requests for medical services and renders clinical determinations.

JOB FUNCTIONS

• Delivers timely notification of clinical decisions that are conditions for discharge. Identifies potential barriers including, but not limited to, social needs, food/housing insecurity, and/or financial issues links members to appropriate community resources upon discharge and follow up as needed
• Collaborates with management, physicians, member representatives, vendors, caregivers and facility discharge planners in discharge planning coordination and transition of care followsup on care and medical services to ensure a high quality safe discharge plan of care. Reviews the Daily Facility Census report to identify activity at assigned facilities and makes outreach to the facilities discharge planning staff to start the discharge planning process.
• Provides education to the discharge planning staff on the available benefits to the member. Participates in approval process for out of network services for members that receive services outside of network services. Participates in weekly review rounds and interdisciplinary care team meetings conducted during a members stay in a facility.
• Works with team in the development of the members discharge plan of care. Conducts a Social Determinants of Health SDOH evaluation and makes the necessary connections to communitybased providers and services as determined by the discharge plan of care.
• Responsibilities Identifies opportunities for alternative care options and contributes to the development of member focused plan of care to facilitate a safe discharge and transition back into the community after an observation stay, a hospitalization or a skilled nursing facility stay. Coordinates with the Authorization and Utilization Management teams to ensure all required authorizations are complete and transferred to the appropriate vendors to enable the execution of the discharge plan of care, including coordination of skilled care and nurse placements

Qualifications

• Current license to practice as a Registered Professional Nurse in New York State
• Minimum two years of experience with strong case management/discharge planning background
• Minimum two years acute inpatient hospital experience in discharge planning required'
• Knowledge of Medicare and Medicaid regulations