If you’ve ever gone to a hospital for care, it’s likely that you met many members of your care team during your stay. From nurses to medical assistants, physicians to sonographers, and more, there are dozens of health care professionals that make up your care team – each of whom are dedicated to ensuring that each patient receives the best possible care for their needs. But it’s care managers who organize your care, collaborate with your care team, and advocate for your wellness and well-being.
Early in 2022, UPMC launched the Clinical Care Coordination and Discharge Planning (CCCDP) career track for nurses and social workers that meaningfully impacts patients throughout their UPMC treatment journey. The new team works with patients throughout their UPMC treatment journey – from day one of admission to post-discharge – ensuring that patients are prepared for a successful discharge and set up to achieve continued improvement following inpatient care. We chatted with some of the Life Changers who have stepped into this essential new career path – read on to learn about their roles in Clinical Care Coordination and Discharge Planning!
"The most rewarding part of my role is the coordination of care between myself, patients, and their families – from beginning to end."
— Daiona M., Sr. Discharge Plan Manager, UPMC Mercy
Question #1: Tell us a little bit about your career journey so far. What led you to the career that you have today?
Bethany R. : I am the Director of Clinical Care Coordination and Discharge Planning at UPMC St. Margaret. I have worked in case management for 12 years, but I am a nurse by background and started my career years ago as an Emergency Room nurse. Discharge planning for me was a way to see a patient through full-circle and ensure that they have what the need to prevent readmissions. I like to learn new things, I have always been a multitasker, and I really enjoy solving problems. In this role, we get to deal with a little bit of everything. It keeps me busy, and I’m never bored!
Pam K. : I really did not know anything about social work until later in my career. Early in my career, I lived in Armstrong and Westmoreland counties and worked with people with an intellectual disability diagnosis. In 2007, I moved to Pittsburgh and got a job with Mercy Behavioral Health. This was my first opportunity to work with social workers and I felt I had found my people! I enrolled at the University of Pittsburgh part-time and completed my Master of Social Work degree in December 2013.
After graduation, I was hired to work at UPMC Shadyside Care Management as a social worker on the inpatient oncology floors. My managers were supportive and always encouraged me to be open to expanding my experience. From Shadyside inpatient, I transitioned to an outpatient social work team at both Shadyside and Presbyterian hospitals. In 2018, the social work supervisor position opened here at Passavant, and I had the opportunity to join the team under Jenny Hall. Jenny was a wonderful mentor and in the fall of 2022, I was lucky enough to be hired to be the new director of the Clinical Care Coordination team.
Question #2: What do you enjoy most about your current role in Clinical Care Coordination/Discharge Planning?
Bethany R. : In this role, I most enjoy the team of people that I work with. We like to have fun and laugh a lot. Also, it is so rewarding when we can ensure that a patient is transitioned out of the hospital with all the resources possible, and it leads to good outcomes. This also often allows patients to return home and live a good life surrounded by family.
Pam K. : Our team touches every patient in our hospital. We make sure that the patient has the safest discharge possible. We also serve as advocates for our patients to make sure their voices are heard. It can be overwhelming for patients and families when admitted to the hospital – we are often seeing people at the worst moments of their lives – and it is our responsibility to make sure the patients fully understand the recommendations being made by the medical team and navigate the complicated referral process on their behalf to make sure the patients have the support they need when they leave.
Question #3: With so many options for employment in health care, why did you choose UPMC?
Bethany R. : I chose UPMC St. Margaret for the family atmosphere I felt when I came to interview. I grew up in a small town, and I like to walk down the hall and know others throughout the hospital. Also, because this job is challenging, but rewarding.
Pam K. : I knew when I got my Master of Social Work Degree that I wanted to move into the healthcare field. I interviewed and was offered positions with both Allegheny General Hospital and Shadyside, but I chose UPMC because the people that interviewed me seemed to care about not only the open position, but also my interests and goals for my career. I have had the opportunity to learn and work with many wonderful people at UPMC and honestly feel lucky to be a part of my current team!
Pam K., Director, Clinical Care Coordination & Discharge Planning, UPMC Passavant
Bethany R., Director, Clinical Care Coordination & Discharge Planning, UPMC St. Margaret
"It is so rewarding when we can ensure that a patient is transitioned out of the hospital with all the resources possible, and it leads to good outcomes. This also often allows patients to return home and live a good life surrounded by family."
— Bethany R., Director, Clinical Care Coordination & Discharge Planning, UPMC St. Margaret
Are you a social worker or a registered nurse interested in care management, case management, or care coordination? Browse our open roles to find your next opportunity on UPMC’s Clinical Care Coordination and Discharge Planning team.
