Major Responsibilities:Assist with discharge planning and collaboration with treatment team members to complete the discharge in a timely manner. Attends and participates in team meetings.Communicates effectively with patients, family, treatment team and community agencies and facilities resolution of issues which could impact continuity of care (e.g., application requirements, transfer paperwork).Provides program education to patients and families. Documents activity and education provided according to department/program standards. Educates patient on the discharge process. Focuses on positive discharge experience for all patients transitioning to the next level of care.Establishes aftercare services including referrals for housing, case management, transportation services, meal services, peer support groups, and vocational referrals.Acts as a liaison with referral sources, employer/schools, EAP and community agencies to keep them informed of discharge plan.Acts as a primary contact for Milwaukee County Emergency Detention patients. Works as a liaison between IP physicians and the legal team to decide patient's IP status (voluntary, stipulations, or commitment proceedings).Contacts physicians daily for availability to accept patients transitioning to PHP. Manages MD dashboard for PHP. Assigns a physician to patients stepping down to PHP.Acts as a primary contact for patients to call post discharge when encountering a problem transitioning to the next level of care. Resolves transportation issues post discharge.Meet with patients that have been readmitted within 30 days to discuss barriers to treatment. Discuss treatment options with patient and treatment team to ensure positive treatment outcomes upon discharge.Provides program orientation to patients, and coordinate meet and greets for our direct program admissions to ensure a smooth transition to the next level of care. Completes outreach calls to patients recently discharged from inpatient level of care who fail to show for hospital based programming in an attempt to reengage the patient in treatment.Must be able to demonstrate knowledge and skills necessary to provide care appropriate to the age of the patients served. Must demonstrate knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient's status and interpret the appropriate information needed to identify each patient's requirements relative to his/her age-specific needs, and to provide the care needed as described in the department's policies and procedures. Age-specific information is developed further in the departmental job standards.
Licensure, Registration, and/or Certification Required:None Required.
Education Required:Bachelor's Degree in Social Work or related field.
Experience Required:Typically requires 1 year of experience in mental health environment including crisis intervention and working with chronic behavioral health patients.
Knowledge, Skills & Abilities Required:Excellent oral and written communication skillsBasic proficiency in Microsoft Office (Word, Excel, Powerpoint, Access) or similar productsExcellent organizational skills and ability to set prioritiesAbility to provide on call service as needed
Physical Requirements and Working Conditions:Will frequently be required to lift up to 25lbs without assistance.Will occasionally be required to lift over 25lbs with assistance.May be exposed to the following hazards: mechanical, electrical, chemical, blood and body fluids. Must wear personal protective equipment as necessary.Must be able to sit, stand, and walk, throughout the workday.May be exposed to verbal or physical outbursts from patients and/or their families.
This job description indicates the general nature and level of work expected of the incumbent. It is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities required of the incumbent. Incumbent may be required to perform other related duties.