Discharge Planner- Juvenile Detention

CHP Health • San Diego, CA

1d • Onsite

About The Position

The Discharge Planner coordinates comprehensive pre-release care management for youth in juvenile detention facilities who are eligible for California Advancing and Innovating Medi-Cal (CalAIM) Justice-Involved services. The role supports successful transitions from custody to the community by creating individualized transition plans, coordinating healthcare and social services, and promoting continuity of care before and after release.

The Discharge Planner works with facility staff, Medi-Cal Managed Care Plans, behavioral health providers, probation officers, community organizations, schools, and families to address youth medical, behavioral health, educational, housing, and social support needs. The position includes care coordination, discharge planning, collaboration, documentation and compliance, and youth advocacy. Work is performed in juvenile detention facilities, with occasional travel and flexibility to accommodate release schedules and multidisciplinary meetings.

Requirements

• Bachelor's degree in Social Work, Psychology, Human Services, Public Health, Nursing, Counseling, Criminal Justice, or a related field.
• At least two years of experience in case management, care coordination, discharge planning, behavioral health, juvenile justice, child welfare, or community health.
• Experience working with adolescents and transitional-age youth.
• Valid California driver's license and ability to travel locally as required.
• Knowledge of adolescent development, trauma-informed care, restorative practices, and positive youth development.
• Understanding of juvenile justice systems, child-serving systems, and community resources.
• Strong care coordination and interdisciplinary collaboration skills.
• Ability to build rapport with youth and families from diverse cultural and socioeconomic backgrounds.
• Excellent communication, motivational interviewing, conflict resolution, and documentation skills.
• Strong organizational and time management abilities.
• Ability to maintain confidentiality and exercise sound professional judgment.
• Proficiency with electronic health records and Microsoft Office applications.

Nice To Haves

• Knowledge of Medi-Cal, CalAIM, Enhanced Care Management, Community Supports, and Justice-Involved Initiative services.
• Experience working within juvenile detention facilities, probation, behavioral health, or community-based organizations.
• Bilingual proficiency in English and Spanish.

Responsibilities

• Identify and engage youth eligible for CalAIM Justice-Involved pre-release services.
• Conduct comprehensive biopsychosocial, medical, behavioral health, and social needs assessments.
• Develop individualized transition and care plans that support community reintegration.
• Coordinate pre-release services in accordance with CalAIM Justice-Involved Initiative requirements.
• Promote continuity of physical health, behavioral health, dental, substance use treatment, and specialty care services upon release.
• Schedule post-release medical, behavioral health, and specialty appointments before release whenever possible.
• Collaborate with multidisciplinary treatment teams to develop comprehensive discharge plans.
• Coordinate medication continuity, including prescriptions and access to medication upon release.
• Assist youth with obtaining identification documents, Medi-Cal activation or reinstatement, and other benefits as appropriate.
• Coordinate referrals for housing, education, employment supports, vocational programs, mentoring, and community resources.
• Facilitate warm handoffs to community providers and Enhanced Care Management providers when applicable.
• Serve as the primary liaison among the detention facility, Managed Care Plans, community providers, probation, behavioral health agencies, schools, and families.
• Participate in multidisciplinary case conferences and discharge planning meetings.
• Build and maintain collaborative relationships with community-based organizations serving justice-involved youth.
• Educate youth and families about available CalAIM services and community resources.
• Maintain timely, accurate, and complete documentation in electronic health records and required databases.
• Ensure compliance with CalAIM Justice-Involved Initiative requirements, Medi-Cal regulations, HIPAA, state confidentiality laws, and organizational policies.
• Track outcomes, referrals, service utilization, and required performance metrics.
• Complete documentation for quality improvement, audits, and reporting.
• Advocate for youth to reduce barriers to healthcare, behavioral health treatment, housing, education, and community services.
• Promote youth-centered, family-centered, culturally responsive, and trauma-informed care.
• Support youth in developing self-management skills and understanding available community supports.
• Complete comprehensive assessments and transition plans in a timely manner.
• Complete pre-release care coordination activities and support timely connections to primary care, behavioral health, and community services.
• Maintain documentation timeliness and completeness and comply with CalAIM standards and organizational quality metrics.

Benefits

• Medical, dental, and vision coverage with multiple plan options.
• Employer-paid life and disability insurance.
• 401(k) with company match.
• Paid time off, paid holidays, and paid sick leave.
• Continuing education and professional development support, including license renewal and CME/CEU reimbursement where applicable.
• Malpractice coverage for clinical roles.
• Employee Assistance Program.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level