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Job Summary:

The Discharge Planner is a caseworker for Hematology-Oncology and Blood and Marrow Transplant (BMT) patients.
Facilitates and provides patient education preparing for discharge. Communicates in an appropriate manner with the
community support team, social worker and other support services to make a comprehensive post-discharge care plan for
the patient. Arrange and confirm post-discharge care for a patient who needs specialized care such as Nursing Home
placement, subacute Rehabilitation, Home Health/Hospice, Oxygen and equipment, and coordinate disability/ICTF
initiation.

Core Responsibilities and Essential Functions:

Demonstrates the knowledge of Hematology/Oncology and BMT patient care services. Able to prepare
patient-specific discharge summary for the subsequent healthcare provider. Coordinates and tracks the
patients follow-up appointment and make sure the patients follow-up is scheduled with the appropriate
doctor of cancer center or referral physician. Coordinates arrange and schedule post-discharge services with
Nursing home, Subacute Rehabilitation, Home Health/Hospice care.
2. Coordinates and assists arrangement for Equipment/Oxygen, applications for medication, medication copay,
disability/Indigent Care Trust Fund (ICTF) initiation with Chamberlin Edmonds. Sending out the treatment and
medical records to the referring physicians in a timely manner. Coordinate all post-discharge appointments,
infusion schedule, and other specialties. Entering relevant transplant or hematological information in BMTOTTR.
Takes part in the morning round with the attending.
3. Collaborates with physicians, caregivers, patient, family, other departmental team members, and the payor
to proactively develop and implement a safe and appropriate discharge plan which would be effective and
cost-efficient. Maintain current knowledge of payor requirement to support providing clinical reviews that
are complete and focused. Maintains working knowledge of Medicare, Medicaid, Tricare, and private
insurance company coverage, especially for transplant patients.
4. Develops and provides education to patients, family members, and caregiver of transplant recipients.
Coordinates and notifying BMT nurse navigators of discharges and follow-up plans. Facilitates patient care
delivery for Hematology-Oncology and post-transplant patients. Performs assessments, plans, implements,
coordinates, monitors, and evaluates options to facilitate the continuum of care.
5. Participates in all departmental and interdepartmental meeting related to discharge planning function.
Participates in team meetings that foster interdepartmental collaboration with the patient and their family
as deemed necessary, this includes weekly multidisciplinary meetings, weekly intake meeting, and monthly
QM meeting. Provides input in such meetings regarding utilization management and discharge planning.
Identify opportunities for improved performance in discharge planning.
Performs other duties as assigned
Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

• Bachelors Social Work or Bachelors Other

Required Minimum License(s) and Certification(s):

All certifications are required upon hire unless otherwise stated.

Additional License(s) and Certification(s):

LCSW Upon Hire Preferred

Required Minimum Experience:

Education clarification: Bachelor's degree in Social Work, human services, or
related field Required and
Minimum 2 years related field more years of experience in social work, discharge planning. Required and

Required Minimum Skills:

Computer literacy, excellent organization, and communication skills
Medical record abstraction, insurance plans, knowledge on oncology, health care in Nursing Homes, subacute rehabilitation, home health/hospice care.

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