Discharge Planner/Care Coordinator

Job Summary

The Discharge Coordinator will act in a liaison role with clients with behavioral health conditions to ensure appropriate outpatient care and supportive services are accessed after inpatient care or incarceration, as well as to provide social assessments and client education. Additionally, this role will work with local rural health care providers, inpatient behavioral health facilities, and county detention centers to improve the overall discharge process. The Discharge Coordinator will serve in a regional role, receiving referrals from hospitals and county detention centers and engaging directly with clients, with the flexibility of engaging telephonically and in the community. Interest in learning to work with clients who may be experiencing significant addiction and/or behavioral health conditions is important for this role.

Essential Functions

• Promote the mission, vision, and values of the organization.

• Create a positive experience and relationship with the client
• Ability to maintain case load through appropriate process
• Help client set goals and develop a care plan to achieve those goals
• Proactively engage the client to manage their own health and healthcare
• Support the client to improve their wellbeing by attending regular visits to outpatient providers
• Help the client engage with mental health and substance use treatment
• Support the client to ensure pick-up of their prescriptions
• Provide client referrals to community resources and assist with accessing benefits
• Conduct post discharge activities from hospital facility and support connection to social services
• Support member to engage in work or volunteer activities, if desired, and develop stronger social supports through deeper connections with friends, family, and their community
• Partner with care team (community, providers, internal staff)

• Knowledge and continued learning of community cultures and values

Non-Essential Functions

• Perform other duties as assigned

Professional Requirements

• Adhere to dress code, appearance is neat and clean.
• Complete annual education requirements.
• Maintain patient confidentiality at all times.
• Report to work on time and as scheduled.
• Wear identification while on duty.
• Maintain regulatory requirements, including all state, federal and local regulations.
• Represent the organization in a positive and professional manner at all times.
• Comply with all organizational policies and standards regarding ethical business practices.
• Communicate the mission, ethics and goals of the organization.
• Participate in performance improvement and continuous quality improvement activities.
• Attend regular staff meetings and in-services.

Qualifications

• High school diploma or equivalent
• Minimum of one year experience in clinical field, preferably hospital setting
• Knowledge and/or experience with behavioral health or substance abuse use disorders preferred
• Previous case management experience preferred
• Must reside in local community
• Knowledge of culture and values of community
• Familiarity with the resources available in the community

Knowledge, Skills, and Abilities

• Knowledge of behavioral health services preferred
• Strong organizational and interpersonal skills
• Ability to determine appropriate course of action in more complex situations
• Ability to work independently, exercise creativity, be attentive to detail, and maintain a positive attitude
• Ability to manage multiple and simultaneous responsibilities and to prioritize scheduling of work
• Ability to maintain confidentiality of all medical, financial, and legal information
• Ability to complete work assignments accurately and in a timely manner
• Ability to communicate effectively, both orally and in writing
• Ability to handle difficult situations involving patients, physicians, or others in a professional manner

Physical Requirements and Environmental Conditions

• Physically demanding, high-stress environment
• Position may require travel between associated clinics and off-site departments
• May be up walking on feet up to 8 hours per day
• May need to sit for up to 2-6 hours per day
• Pushing and pulling heavy objects
• Full range of body motion including handling and lifting
• Light to moderate work with 30 pounds maximum weight to lift and carry

• Position requires reaching, bending, stooping, and handling objects with hands and/or fingers, talking and/or hearing, and seeing.