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Form of workPosition Summary
The Discharge Planner will provide crisis intervention services, assessment and therapeutic recovery-based services to clients presenting to Crisis Services and to those assigned to the Inpatient Unit. The Discharge Planner provides assistance to the Social Services Lead and other treatment teams in coordinating the care of clients.
This position may provide day-time emergency on-call based on supervisory discretion for coverage issues.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
Clinical Services Activities
The Discharge Planner will provide crisis intervention services, assessment and therapeutic recovery-based services to clients presenting to Crisis Services and to those assigned to the Inpatient Unit. The Discharge Planner provides assistance to the Social Services Lead and other treatment teams in coordinating the care of clients.
This position may provide day-time emergency on-call based on supervisory discretion for coverage issues.
Essential Duties and Responsibilities
The essential functions include, but are not limited to the following:
Clinical Services Activities
- Manages crisis situations with clients over the phone and face-to-face. Determines disposition in terms of follow-up care.
- Works with IPU staff to coordinate discharge planning for clients discharged from the IPU.
- Conducts psychosocial assessments, Adult Needs and Strengths Assessment (ANSA), and other assessments as appropriate.
- Assists Inpatient Program Administrator and Social Services Lead in case management activities for inpatient clients.
- Participates in the provision of inpatient therapeutic program activities as appropriate.
- Participates with treatment teams in the assessment and implementation of care for inpatient clients.
- Co-facilitates with charge nurse/team leader in treatment planning process through staffing meetings.
- Documents in individual client charts progress and needs for recovery.
- Acts as a liaison with the Courts involving Inpatient cases.
- Under the supervision of the master’s level Social Worker, conducts intakes and psychosocial histories for clients admitted to the Inpatient Unit.
- Coordinates discharge planning in conjunction with treatment team:
- Conducts collateral contacts with family members and/or CMHC or other professionals at intake to clarify history of presenting problems and expectations for hospitalization.
- Provides treatment updates to family members and/or other professionals during treatment.
- Conducts discharge conferences with client, family, or collateral professionals for continuity of care and transition of services as requested.
- Facilitates transfer to State operated facilities, nursing homes, or other placements by making all necessary arrangements (date of transfer, transportation, paperwork, transfer packets, etc.) in tandem with IPU Treatment Team
- Conducts psycho-educational recovery-based groups on topical information for inpatient clients as assigned.
- Attends all reports, staffing and reviews necessary for case coordination and disposition.
- Facilitates necessary documentation completion for involuntary commitments.
- Cultivates and utilizes a broad and effective referral network to assist with the external placing of clients when indicated.
- Documents treatment and emergency contacts by following established policies and procedures.
- Develops linkage systems with community resources along with the treatment team to ensure that discharged clients have a well-planned and designed community support system.
- Serves as liaison with area offices to assure continuity of care.
- Responds to inpatient and Access Center clinical emergencies as needed.
- Answers crisis calls and documents appropriately.
Administrative Responsibilities
- Develops and maintains a database of local, state, and regional resources to assist clients in crisis situations.
- Provides information and referral services as appropriate. Coordinates referrals for children’s services. Provides screening and collects necessary information to make appropriate referrals.
- Contacts insurance companies for verification and authorization of benefits and pre-certification, as necessary.
Staff Development Activities
- Actively participates in the Center’s Staff Development Programs by fulfilling identified items on the Individual Employee Development Plan (IEDP).
- Participates in multi-disciplinary staffing of inpatient clients.
- Completes Bloodborne Pathogen/TB/Infection Control/Risk Management training at employment and annually thereafter.
- Attends conferences, workshops, meetings, in-services, etc. to enhance professional knowledge and development according to the need identified on the IEDP.
- Serves on Inpatient Performance Measurement and other committees as assigned.
- Demonstrates active involvement in clinical and administrative supervision as evidenced by constructive participation, initiative, and apparent effort.
- Attends full-staff, team meetings, etc. as appropriate to position.
- Keep relevant skills current to continue working on the Inpatient Unit: e.g. CPR, First Aid, Handle with Care training, etc.
- Takes responsibility for self-directed learning activities and keeping abreast of Center and Unit changes.
Record Keeping Activities
- Completes documentation as applicable, to ensure fair and accurate data collection for billing, fee setting, the Electronic Health Record (EHR) and other purposes in accordance with agency policies and procedures.
- Completes attendance reports, PTO requests, travel vouchers, staff development requests, employee self-evaluations, etc. accurately and efficiently in accordance with agency policies and procedures.
- Completes documentation of client progress, family contacts and discharge plans in client’s chart/EHR.
Knowledge and Skill Required
Knowledge of and experience with brief models of individual, family, and group treatment.
Knowledge of service area networking systems available for clients and/or families of clients.
Demonstrated sensitivity to cultural issues in a rural, poverty area.
Knowledge of client activities in a recovery based inpatient setting.
Knowledge and experience with crisis intervention services.
Good communication skills and ability to work within a team setting.
Nonjudgmental attitude and desire to work with clients.
Knowledge of computers and data entry.
Must have completed training in CPR and First Aid.
Special Requirements for Position
Willingness to work a flexible work schedule such as evening and weekend hours to be available during hours that clients/families can be seen.
Valid driver’s license with a good driving record.
Displays positive consumer interaction and ability to handle crisis situations.
Demonstrations compassion and dedication to assisting clients in meeting and obtaining their recovery goals.
Minimum Qualifications (Knowledge, Skills, and Abilities)
- Bachelor’s degree in social work preferred or related field preferred.
- Experience working in an inpatient or residential setting as an interdisciplinary treatment team member.
- Basic computer skills to enter data into an electronic health record.
- Must have proven organizational skills and experience working within a team setting.
