Provides direct services in the home, community or office, with a primary focus on supporting members transitioning from the hospital to community-based care. Facilitates and coordinates hospital discharge planning and follow-up services to help ensure a safe and successful transition back into the home and community. Interventions may be 1:1 or group based. Performs crisis stabilization functions and assists members/parents/guardians with connecting to community resources. Conducts assessments and completes necessary documentation and paperwork. Serves as a central support for members throughout the transition and beyond. Performs case management functions as needed, including behavior coaching, member medication monitoring, and clinical care coordination with resources both within and outside the agency. Collaborates with hospital providers, community partners, members, and families to coordinate services, address barriers to care, and support continuity of treatment following discharge.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
Job Type
Full-time
Career Level
Mid Level