Discharge Planner (EastPointe) - AltaPointe Health

General Responsibilities:

• Serves as liaison between unit’s physician and treatment team members, families and outside agencies
• Assists consumers and families with discharge planning and provides referral information as necessary
• Facilitates admission to AltaPointe program services or other agencies as appropriate
• Advocates on behalf of the consumers to secure community resources
• Reviews progress of consumers with assigned therapist and assists with discharge planning for consumers.
• Provides warm handoff to outpatient services or the next level of care
• Effectively communicates with unit therapist, nurses, doctors, coordinator of social services, supervisor and other members of the treatment team
• Ensures clinical information is forwarded to other AltaPointe programs and agencies as appropriate for continuity of care and provision of aftercare services
• Coordinates with treatment team to obtain releases of information for medical records
• Requests/tracks receipt of records from other treating facilities/outpatient physicians
• Obtains aftercare appointments – including sending records to outpatient providers
• Distributes and collects consumers surveys
• Maintains a resource list of various outside providers for the purpose of coordinating aftercare services
• Scans and emails referrals for group home screenings
• Provides Unit census to treatment team members
• Facilitates Nursing Home/Home Health referrals as necessitated completing necessary releases with consumers
• Documents daily discharge planning efforts.
• Effectively demonstrates the application of adult specific competencies listed above
• Adheres to professional code of ethics

Supervision and Consultation:

• Seeks supervision and consultation as needed
• Accepts and employs suggestions for improvement
• Actively works to enhance skills

Record Keeping:

• Documents in a timely fashion per AltaPointe policy
• Documents appropriate, complete, and comprehensive reports
• Documents in a clear and concise manner
• Documents legibly

Courteous and respectful attitudes towards consumers, visitors, co-workers and outside agency staff

• Treats consumers with care, dignity and compassion
• Respects consumer’s privacy and confidentiality
• Is pleasant and cooperative with others
• Assists consumers and visitors as needed
• Personal values don’t inhibit ability to relate and care for others
• Is sensitive to the consumer’s needs, expectations and individual differences
• Is gentle and calm to consumers and families
• Administrative and Other Related Duties as Assigned:
• Actively participates in Performance Improvement activities
• Actively participates in AltaPointe committees as required
• Completes assigned tasks in a timely manner
• Accesses appropriate community resources according to consumer needs
• Follows AltaPointe policies and procedures
• Attends regular workshops and in-services as appropriate

Physical Requirements of the Job: 

• There is frequent standing, sitting and walking which are in bursts of 5-10 minutes;
• however, extended sitting could be up to 1 hour
• There is occasional forward bending from the hips while kneeling to reach to the side
• There is an occasional need to be able to assume a full squat/lunge from a standing
• position
• There is an occasional need to maintain back extension while being on stomach with
• one’s own body weight on hips and legs, this position is maintained for several minutes
• Occasionally, be able to put one’s own body weight on one knee and one elbow on the
• same side of one’s body
• Occasionally, be able to kneel and reach to same side toward floor
• Strong grasp is needed to use keys to open doors throughout the facility and to maintain
• constant contact with a consumer during a take down procedure
• Pushing/pulling force up to 25 pounds occasionally during shift
• Fine manipulation/dexterity to handle medical records and complete documentation
• Occasional step ladder climbing to retrieve medical records that are on higher shelves
• Lifting various ranges from the floor to overhead with weights up to 10-15 pounds when handling medical records
• Carrying up to 10-15 pounds various distances throughout the facility

Bachelor’s degree preferred in Social Work (BSW). Hospital Case Management and/or discharge planning experience preferred. Must be 23 years of age or older with a valid Alabama Drivers License and proof of current liability insurance. Knowledge in adult specialty, outlined below, to be attained within (6) months of employment:

• Knowledge of psychiatric disorders in the adult population
• Knowledge of Intellectual and Developmental Disabilities
• Knowledge of Substance Use Disorders
• Knowledge of Housing programs
• Knowledge of VA programs
• Knowledge of area shelters
• Knowledge of Intellectual Disability placement services
• Knowledge of inpatient substance abuse services
• Basic knowledge of the nature of addiction for referral purposes
• Knowledge of behavior management, crisis intervention and interventions common to acute psychotic consumers, as well as to non-violent crisis intervention practices
• Knowledge of community resources
• Knowledge of nursing home and assisted living facility admission requirements
• Knowledge of cultural diversity
• Knowledge of educational methods appropriate to adults with psychiatric disorders
• Knowledge of psychiatric rehabilitation principles
• Knowledge of involuntary commitment laws, procedures and court policies