Discharge Planner; LPN

Job Description Summary Hours &

Location:

Full Time:
Monday-Friday EST Collier county, FL (onsite at NCH North and PRMC Pine Ridge)
Coordinates discharge planning and care transition activities for hospitalized patients within the Millennium Physician Group Hospitalist program. Assesses discharge needs, collaborates with physicians, nurses, case managers, patients, families, and community providers, and facilitates appropriate post-acute services to promote safe, timely transitions from the hospital. Supports continuity of care by coordinating services, educating patients and caregivers, addressing barriers to discharge, and ensuring compliance with regulatory and organizational requirements.

The Discharge Planner performs professional clinical work under established policies, evidence-based practices, and interdisciplinary care processes. Exercises clinical judgment in coordinating routine and moderately complex discharge plans, escalating higher-risk situations and complex psychosocial or medical issues as appropriate. Work primarily impacts individual patient outcomes, care transitions, and operational efficiency.

How will you make an impact & Requirements

Key Responsibilities
• Assess patients' discharge planning needs through review of medical records, interdisciplinary collaboration, patient interviews, and evaluation of clinical, functional, psychosocial, and environmental factors affecting post-discharge care.
• Develop and coordinate individualized discharge plans that align with physician orders, patient goals, payer requirements, and available community resources.
• Collaborate with hospitalists, nursing staff, case managers, therapists, pharmacists, social workers, and ancillary departments to coordinate timely, safe, and effective patient discharges.
• Arrange post-acute services including home health, skilled nursing facilities, rehabilitation services, durable medical equipment, hospice, outpatient therapies, transportation, and community-based resources as appropriate.
• Educate patients and caregivers regarding discharge instructions, medications, follow-up appointments, disease management, warning signs requiring medical attention, and available community resources.
• Identify barriers to discharge including insurance authorization delays, transportation needs, caregiver limitations, equipment availability, housing concerns, or social determinants of health, and coordinate appropriate interventions.
• Communicate with primary care providers, specialists, post-acute providers, payers, and external agencies to facilitate continuity of care and reduce avoidable readmissions.
• Document discharge planning assessments, care coordination activities, referrals, patient education, and transition plans accurately within the electronic health record in accordance with organizational standards and regulatory requirements.
• Monitor discharge timelines, transition metrics, and assigned patient caseloads while supporting organizational goals related to length of stay, readmission reduction, patient satisfaction, and quality outcomes.
• Participate in interdisciplinary rounds, quality improvement initiatives, patient safety activities, and care transition programs that improve discharge processes and patient outcomes.

Certificates, Licenses, Registrations Registered Nurse, LPN, Social Worker preferred

Benefits:3 weeks PTO & 8 paid holidays

Medical, Dental, Vision Employer Paid Basic Life & Short Term Disability coverage (goes into effect after 1 year of full-time employment)401(k) with match

Employee Wellness Other Employee Discount programs like Tickets at Work and cell phone discounts

Other benefits:
Dependent Care FSA, Voluntary Life, Long Term Disability, Critical Illness, Pet Insurance, and…