Job Description
Job Description
Overview
The RN Discharge Planner H coordinates daily clinical care, utilization management, and care management activities while ensuring compliance with nursing standards and regulatory requirements. This role provides clinical oversight of the discharge planning process for CalAIM-eligible individuals, reviewing and approving reentry care plans to ensure they are clinically appropriate and aligned with Enhanced Care Management and Community Supports. The position conducts assessments, leads care coordination with managed care plans and community providers, and supports continuity of care. As the accountable clinician for discharge planning, this role helps facilitate safe and effective transitions of care.
Responsibilities
- Coordinate clinical reviews, utilization management activities, and application of established care management criteria.
- Review clinical documentation, referrals, and pre-certification requests to ensure compliance with department guidelines and regulatory requirements.
- Collaborate with medical directors, providers, site personnel, and care management teams to support patient care, discharge planning, and continuity of care.
- Monitor utilization data, claims reviews, and referral activity to ensure accuracy, appropriate coding, and effective cost management.
- Provide clinical oversight of reentry care plans and coordinate with managed care plans, community providers, and CalAIM partners to support successful care transitions.
Qualifications
Education
- Unrestricted, current RN license in state of employment
- BSN, CCM preferred.
Experience
- Two (2) years’ clinical experience with Discharge Coordination experience
- Previous correctional/detention facility experience
Licenses/Certifications
- Must maintain all certifications, educational requirements, licensing, etc. for RN license