Under the direction and oversight of the Manager of Discharge Planning, the Discharge Planning Nurse is responsible and accountable for coordination of services for members of Bright Health admitted to and/or discharged from an inpatient acute or skilled facility. The Discharge Planning Nurse coordinates all systems/services needed for an organized, multidisciplinary, patient centered team approach, and cost-effective care for our members. The Discharge Planning Nurse follows and manages the course of treatment for patients while coordinating care with physicians, nurses, case managers and other staff from outside Bright and within Bright to ensure quality care and safe outcomes. The Discharge Planning Nurse also conducts initial and ongoing assessments, incorporates disease management protocols, ensures continuity of care through discharge planning and utilization of resources, and shifts cost to appropriate payers.

ROLE RESPONSIBILITIES

• Responsible for managing a continuum of care from admission and two weeks post discharge for assigned patients.
• Demonstrates a multidisciplinary approach in identifying problems, communication and negotiating with the member’s PCP, family members, caregivers, other members of the health care team and community resources.
• Monitor operational key performance indicators to track service delivery against targets.
• Researches and refers members to sources for alternative funding, community services and other services which may provide support to the patient and family
• Enforce UM policies and procedures to ensure compliance with state and federal agencies as well as accreditation standards.
• Support the development and maintenance of standard operating procedures related to corresponding program functions.
• Participate in the development of operating models to execute utilization management solutions.

SUPERVISORY RESPONSIBILITIES

This position has supervisory responsibilities for members of the Utilization Management team.

EDUCATION, TRAINING, AND PROFESSIONAL EXPERIENCE

• A minimum of an associate degree in Nursing desired.
• Three (3) or more years of supervisory experience within a consumer support function
• Two (2) or more years of healthcare related experience
• Awareness and experience with HIPAA requirements for healthcare communication
• Prior experience with URAC accreditation is desired, but not required
• Formal training in Six Sigma management techniques is desired, but not required

PROFESSIONAL COMPETENCIES

• Approaches challenges calmly and objectively to identify the best solution
• Capable communicator that can interact with others at multiple levels within the organization, customers and providers
• Leads through influence and example
• Strong operational mindset and uses data to draw insights
• Thrives on driving results in a collaborative environment

LICENSURES AND CERTIFICATIONS

• An active, Licensed Practical Nurse (LPN) license to practice as a health professional in a state or territory of the United States is required for this role.

WORK ENVIRONMENT

The majority of work responsibilities are performed in a remote work from home setting, carrying out responsibilities sitting/standing at a desk/table and working on the computer. Travel is not required.

For individuals assigned to a location(s) in California, Bright Health is required by law to include a reasonable estimate of the compensation range for this position. Actual compensation will vary based on the applicant’s education, experience, skills, and abilities, as well as internal equity. A reasonable estimate of the range is $20.80-$31.20 Hourly.

Additionally, employees are eligible for health benefits; life and disability benefits, a 401(k) savings plan with match; up to 21 days of PTO, 10 paid holidays, plus 2 floating holidays per year; and a lifestyle spending account.