Discharge Coordinator jobs in Chico, CA

Description

JOB SUMMARY:  Under administrative direction and supervision of the Director of Clinical Services, responsible for aiding the clinic team with medication coordination and discharge planning of Redwood Coast PACE participants. Responsible for maintaining pharmacy database as well as ordering, distribution, and discontinuing of participants medications per provider orders. Maintains all required documentation for medication and treatment administration. Collaborates with the interdisciplinary team to develop and implement effective discharge plans for PACE participants who are being discharged from various healthcare settings, such as hospitals, rehabilitation centers, or skilled nursing facilities. Position works closely with participants, their families, caregivers, and community resources to facilitate a safe and successful transition back to their homes, and to promote optimal medication adherence.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Medication Coordination

1. Processes all medication orders for participants through direct input or processing of medication orders input by provider. Provides full, complete, and legal prescriptions to dispensing pharmacy as defined by pharmacy protocol and State/Federal regulation.
2. Coordinates with pharmacy and Clinic to maintain participant medication schedules through implementation of new medication orders, mid-cycle medication changes, discontinuations, and reconciliations through transition process.
3. Responsible for medication reconciliation through transition periods (Long Term Care (LTC)/Hospital/Assisted Living Facility (ALF) discharge) for all participants and facilitating any changes required.
4. Communicates with both Redwood Coast PACE and community-based providers in regard to medication orders, clarifications, and pharmacy recommendations, as well as communication between pharmacy and prescriber.
5. Coordinates with local pharmacies to obtain urgent medications that are not available through on-site dispensing. Coordination involves transmission of medication order, demographics, and insurance billing information.
6. Inventories and maintains on-site medication stock as provided through pharmacy, as well as applicable equipment, computer maintenance, and reporting functions.
7. Enters all medication orders for new enrollments, setting up pharmacy cycle, delivery system, assistive systems if needed, linking diagnosis information to medications (through written History and Physical (H&P)), and verifying all information in writing with participant’s primary care provider. Coordinates medications for dis-enrolling participants to provide as needed for a period of twenty-eight (28) days after leaving program.
8. Communicates with participant and/or family as needed or required.
9. Conducts medication reconciliation through transition periods (Skilled Nursing Facility (SNF)/Hospital/Assisted Living Facility (ALF) discharge). Handles participant health information necessary to document, maintain patient privacy/confidentially, and carry out responsibilities of the position.
10. Coordinates delivery of medications to participant’s residences or facilities, as needed, utilizing PACE transportation or contracted courier services.

Discharge Coordination:

1. Collaborate with the interdisciplinary team (IDT), including physicians, nurses, therapists, social workers, and other healthcare professionals, to contribute to assessment of participants' needs and develop comprehensive discharge plans based on their individual requirements.
2. Coordinate with healthcare providers, community organizations, and service agencies to arrange necessary resources, equipment, and support services required for participants' successful discharge and transition.
3. Ensure seamless transitions by arranging transportation, ensuring scheduling of follow-up appointments, coordinating medication management, and communicating pertinent information to the receiving healthcare team.
4. Maintain accurate and up-to-date documentation of all IDT assessments, discharge plans, coordination efforts, and participant interactions in compliance with organizational and regulatory requirements.
5. Serve as an advocate for participants, ensuring their needs and preferences are communicated effectively to the healthcare team and assisting in resolving any barriers to quality care.
6. Participate in quality improvement initiatives, performance monitoring, and outcome measurement efforts to enhance the discharge planning process and overall participant experience.

General Nursing:

1. Acts in a manner consistent with agency values.
2. Other duties as assigned, including providing other nursing services as directed by the Director of Clinical Services.

Qualifications

EDUCATION &/or EXPERIENCE:

1. Must have a high school diploma or GED Equivalent and successful completion of a Licensed Vocational Nurse Certification program.
2. One (1) year of experience working with a frail or elderly population preferred.
3. Relevant experience in discharge planning, care coordination, case management, medication administration/coordination or a related healthcare field.

LICENSES OR CERTIFICATES:

1. Must be a current Licensed Vocational Nurse by the California Board of Vocational Nursing.
2. Current CPR and First Aid certification within six (6) months of hire.
3. Valid California Driver’s License, and personal auto liability insurance required. Must have a personal vehicle in good driving/operating condition, insured for State minimum liability requirements, and that can be used for the applicable job functions noted above.

PRE-SCREENING REQUIREMENTS:

1. Requires clearance of a DOJ and FBI criminal history background check
2. Pre-employment physical and PPD skin test.
3. Requires Motor Vehicle Report verification.
4. COVID-19 and Influenza (flu) vaccines preferred.

JOB SKILLS:

1. Knowledge and experience working with complex interpersonal and clinical situations.
2. Sound verbal and written communication skills to convey information effectively. Ability to communicate effectively and openly with other team members on participant’s status and needs.
3. Ability to work independently and within an IDT, representing a diverse team of various occupations.
4. Possess strong administrative and organizational skills.
5. Excellent interpersonal skills that result in maintaining a positive attitude, team-building and contribute to effective work relationships.
6. Ability to use good judgment, resourcefulness, flexibility, and problem-solving skills.
7. Medical care management knowledge and skills necessary to facilitate and coordinate services in alignment with participant care plans.
8. Ability and interest to work with frail, elderly, or disabled adults to enhance and encourage their independence.
9. Demonstrates the ability to comply with required government regulations.
10. Demonstrates administrative and organizational skills; has ability to train and delegate responsibility among staff.
11. Demonstrates the ability to communicate clearly, written and orally, including ability to speak to community groups and organizations.
12. Demonstrates the ability to be self-directed and to problem-solve.
13. Demonstrates the ability to work as part of a team, remaining flexible to changes in job tasks.
14. Ability to incorporate an understanding of detailed requirements in work activities.
15. Ability to develop and implement action plans.
16. Ability to coordinate, advocate, and cooperate with other agencies for seniors with tact and diplomacy.
17. Proficiency in Microsoft Office, including Word, Excel, PowerPoint, Outlook, and relevant computer programs and software (e.g. electronic health record software, email, internet).  Knowledge of web-based applications such as timekeeping, training, and email programs.

SUPERVISORY REQUIREMENTS:

1. This position has no supervisory requirements.

PHYSICAL REQUIREMENTS:

1. Ability to sit at a desk and interact with a computer screen for extended periods of time.
2. Hand and arm strength sufficient to operate a keyboard for several hours each day.
3. Physical abilities sufficient to move between different staff work areas, communicate with staff and the public, operate a computer, produce reports, talk on the telephone, and travel to other alternative worksites.

ANALYSIS OF PHYSICAL DEMANDS:

Key (Based on typical week): N=Never; R=Rarely (Less than 1 hour per week); O-Occasional (1%-33% of time); F=Frequent (34%-66% of time); C=Constant (over 66% of time)