Job Description

 Summary

In conjunction with the members adult recovery teams, site staff and Utilization Management staff, coordinates members hospital stays and discharge planning.

Essential Duties and Responsibilities:

The position is responsible, but not exclusive, for the following:

  • Initiates discharge plans for new and recent admissions.
  • Provides all appropriate Notices of Action/ Notice of Decision documentation (when applicable).
  • Responsible for all documentation necessary to complete an intake on Members newly enrolled and the Members currently existing with CODAC. This all includes: the Consent for Care and Treatment, Primary Care Physician Coordination forms and any Release of information forms, the entire CORE Assessment, ISP, Crisis Plan, Review of Progress, Legal and Substance abuse history, etc.
  • Proactive discharge assessment by assessing the specific post discharge bio-psychosocial and medical needs of the Member prior to discharge. This process shall include the involvement and participation of the Member and representative(s), as applicable. The Member and representative(s) must be provided with the written discharge plan instructions and recommendations identifying resources, referrals, and possible interventions to meet the Members assessed and anticipated needs after discharge.
  • These requirements apply also to the ITDP (Inpatient Treatment and Discharge Plan), in accordance with the 9 AAC 21, Article 3.
  • Communicates with members adult recovery team and site staff regarding members admission and appropriate discharge planning, transfers records to members site, as appropriate.
  • Interacts with hospital discharge planner, inpatient prescribers, and other appropriate hospital staff regarding initiation and progress of discharge plans.
  • Reviews and takes additional necessary steps to assure progress of discharge plans for CODAC members.
  • Communicates with members adult recovery team and site staff regarding post-discharge needs, appointment schedules and other necessary supports. With this, the ability to coordinate and facilitate an adult recovery team meeting.
  • Coordinates with medical records staff to obtain medical information from members records.
  • In collaboration with members adult recovery team and site staff, prepares outpatient court ordered treatment plan for presentation to the courts.
  • When appropriate, develops aftercare plan with members adult recovery team, prior to reentry into the community.
  • Coordinates transition of care with the members adult recovery team and site staff.
  • Ensures that hospital discharge summary is sent to appropriate site medical records department.
  • Providing appropriate post discharge community referrals and resources or scheduling follow up appointments with the Members primary care provider and/or other outpatient healthcare providers within 7 days or sooner of discharge;
  • Coordinates transfers to transitional sites, as appropriate.
  • On call for hospital enrollments and arrives within 24 hours of notification.
  • Performs other related duties in accordance with agency growth and changes.

Skills / Requirements

Education: 

  • Masters or Bachelors degree in a healthcare field and no related experience OR;
  • Masters or Bachelors degree in a non-healthcare field and 1 year relevant related experience OR;
  • Associates degree in a healthcare field and 1 year related experience OR;
  • Associates degree in a non-healthcare field and 2 years related experience OR;
  • Certified Peer Support Specialist and 2 years related experience OR;
  • High School diploma or General Education Equivalent (GED and 4 years healthcare experience.
  • Is an Arizona Licensed Registered Nurse OR;
  • Is an Arizona Licensed Physicians Assistant who is not working as a medical practitioner;  

Certifications: 

  • Discharge Planner certification from Cenpatico of AZ within 60 days of hire and/or placement in position.
  • Commission Certified Care Manager (CCCM), a plus.
  • Nurse-Licensed Practical, a plus
  • Certified Nursing Assistant, a plus

Additional Requirements: 

  • Valid Arizona Drivers license, proof of current insurance and willingness to use personal vehicle.  Drivers license is an essential requirement for performing duties for this position.
  • Clean Motor Vehicle Record - no more than 2 moving violations or a license suspension in past 3 years.

Skills:

  • Bilingual a plus.
  • Extensive knowledge of community resources.
  • Extensive knowledge of behavioral health challenges which include knowledge of the impacts of mental illness, domestic violence, and the dynamics of addictive behavior.
  • Familiarity with various ethnic and cultural groups.
  • Intermediate to advanced computer skills using MS Office products, Word, Excel, Access, etc., importing/exporting data to/from applications.
  • Ability to communicate effectively both orally and in writing

Application Instructions

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