MMM Discharge Planner

Job Title: MMM Discharge Planner

Location: San Juan, PR (Hybrid: on-site at least 3 days per week)

Duration: Contract - 6 months

Pay Range: $18/hr $19/hr (W2)

Job ID: 373488

About BCforward

BCforward is a leading global IT consulting and workforce solutions firm providing services and support to Fortune 500 and government clients. Founded in 1998, BCforward has grown with our customers needs into a full-service business solutions provider. With delivery centers and offices across North America and India, we take pride in building long-term relationships and delivering excellence through innovation, collaboration, and integrity.

Job Description

The use of this job is limited to the MMM business unit. If you believe this to be the best match for your position, please consult with your Human Resources partner prior to using this job (HRBP should work with Compensation). Acts as a liaison and triage between the inpatient and outpatient care to ensure timely movement of patients through the continuum of care and provide coordination of care. Primary duties may include, but are not limited to: Provide appropriate and timely hospital discharge planning; coordinate arrangements for health care follow-up and resources available for patients. Develop referrals and coordinate services for appropriate community resources as needed. Reviews daily member's census to identify potential members for discharge. Obtains member referrals from Concurrent Review Nurses identified as high risk. For members that qualify, the DP reviews the member's record, contacts the concurrent review nurse and/or PCP to know actual health status an discharge date. Conducts a telephonic health assessment with member, facility discharge planner, caregiver and physician, to identify member's needs. Initiates a discharge plan on each qualified inpatient member within forty-eight (48) hours of admission. Incorporates member and family preferences, and strengths into a collaborative plan of care. Authorizes and/or facilitates access to specialist and therapies. . Advocates, informs, and educates beneficiaries on services and benefits. Develops and updates individualized care plan for beneficiaries. Coordinates care across settings and providers. Identifies and facilitates access to community resources and social services. Conducts risk assessment. Facilitates the implementation of the individualized care plan for each beneficiary. Request consultation and diagnostic reports from network specialists. Conduct performance assessment. Conducts medication reviews. Provides education, acts as an advocate and facilitates access to needed services and resources. For services requiring authorizations, responsible to obtain in advance required forms with required signatures and necessary information. Be aware ware of the medical necessity criteria, as well as Medicare Regulations and other established clinical guidelines, in order to make a coverage determination and coordinate care. Responsible for processing authorizations for the identified services as per authorization policies and procedures. In collaboration with the hospital discharge planner, the DP will coordinate approved services in advance. Will participate and be responsible to discuss qualified cases in the case rounds with the multidisciplinary team to assure adequate and appropriate member's care. Monitors, modifies and updates the discharge plan to assure a timely discharge between all levels of care. Close case once the plan is complete, and establish adequate case disposition. Conducts On-Call to assure that members and providers have access to Health Plan licensed clinical staff 24 hours per day seven days a week. To provide coverage for review of admissions discharge planning during after-hours, weekends, and holidays. To proactively manage discharges, continued stays and facilitate transfers to the most appropriate setting for continuity of care. Requires BS in Nursing or Master Degree in Social Worker. Current Puerto Rico RN or SW license. 3 to 5 five years in clinical experience in an acute care setting, home care or discharge planning preferred. Bi-lingual (English/Spanish) required. For associates working within Puerto Rico who are member or patient facing either in a clinical setting or in the Best Transportation unit, a current PR health certificate and a current PR Law 300 certificate are required for this position.

Registered Nurse (RN) with experience in case management, care coordination, and population health management.

Strong skills in patient outreach, care coordination, transitional care, and chronic condition management. Ability to conduct telephonic assessments, provide patient education, and support individualized care plans.

Experience supporting quality improvement initiatives, including HEDIS measures, reduction of emergency room utilization, and overall healthcare utilization management.

Familiarity with EMR systems and clinical documentation required. Bilingual (English/Spanish) preferred. Strong communication, critical thinking, and organizational skills required.

Work Schedule:

Monday to Friday, 8:00 AM to 5:00 PM. Hybrid schedule with remote work and on-site presence in San Juan at least three days per week or as required to support care coordination, patient outreach, and population health initiatives.

Why BCforward?

At BCforward, we believe in advancing lives and careers. When you join our team, you gain access to:

• Competitive compensation and benefits.
• Opportunities for growth with global clients.
• A supportive, inclusive culture that values innovation and people.
• Exposure to cutting-edge technologies and projects.

About Our Commitment

BCforward is an equal opportunity employer. We value diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, sexual orientation, gender identity, national origin, age, disability, or veteran status.

Interested? Apply Now!

If this sounds like the right opportunity for you, please apply with your most recent resume.