Discharge Planning Specialist

Texas Health & Human Services Commission•Big Spring, TX

4d•$5,747 - $7,254•Onsite

About The Position

The Discharge Planning Specialist (job title: Social Worker III) performs and documents highly complex social services work at Big Spring State Hospital. The position serves as a liaison among patients, legally authorized representatives, involved persons, agencies, and treatment providers to support ongoing care, treatment, and person-centered transitions. The specialist gathers information about patients’ histories, support systems, and psychosocial, economic, and physical needs, and may participate in assessing rights and decision-making capacity. The role focuses on complex cases and post-discharge placement and support. It includes coordinating furloughs, transfers, transitions, and discharges; assisting patients and their representatives with placement options, rights, and planning; and designing and delivering individual and group trainings on rights, decision-making, person-centered thinking, and self-advocacy. The position works under limited supervision with considerable latitude for initiative and independent judgment. It may assign and oversee the work of Social Worker I and II employees and social work students. The position is full-time, regular, day shift, and not eligible for telework. Travel may be up to 10%. Flexibility in work hours may be required, and overtime or extended hours may be necessary. Disaster response or continuity-of-operations duties may require an alternate shift pattern or work location.

Requirements

Must have and maintain a State of Texas Social Workers License (LBSW or above).
At least six months of experience working directly with people with mental, social, or substance use disorders.
Knowledge of human growth and development, behavioral and mental health, developmental and emotional components of physical illness, intellectual and developmental disabilities, social work case-management standards, facility and community resources, and social work practice principles and methods.
Knowledge of community resources for discharging state hospital patients with high or complex needs and of State Hospital discharge policies and procedures.
Ability to work creatively and collaboratively on behalf of patients discharging from state hospitals.
Effective written and verbal communication skills in individual and group settings.
Skill and ability to assign and supervise others’ work.
Accountability for assigned property and limited financial responsibilities.
Skills in interviewing, assessment, planning, intervention, evaluation, case management, mediation, counseling, information and referral, problem solving, supervision, consultation, and advocacy.
Perform duties in accordance with the Texas State Board of Social Work Examiners Code of Conduct, the National Association of Social Workers Code of Ethics, and applicable state and state-hospital policies and procedures.
Must pass fingerprint-based criminal background, pre-employment drug, and specified registry checks.
Must be at least 18 years old for employment at a state-operated facility.
Comply with HHSC immunization policy and state hospital immunization procedures.
Must provide I-9 documentation and satisfy applicable work-eligibility requirements.

Responsibilities

Interview patients, legally authorized representatives, involved persons, and agencies to develop and maintain social histories and identify support systems and psychosocial, economic, and physical needs.
Coordinate communication and information exchange among patients, representatives, involved persons, agencies, facility staff, and treatment providers to support ongoing care and treatment.
Provide counseling and assistance concerning community placement, living options, end-of-life planning, and patient rights under applicable laws, regulations, and policies.
Coordinate transfers, transitions, furloughs, and community-placement discharges using person-centered practices, including referrals for continued treatment and services.
Coordinate tours of discharge options and work with families, courts, Local Mental Health Authorities, state and judicial systems, providers, receiving facilities, and other stakeholders to support orderly transitions.
Help obtain documents needed for discharge planning and coordinate transfer arrangements, including transportation and the transfer of patient information, possessions, and medication.
Design and deliver individual and group training on rights, decision-making, person-centered thinking, and self-advocacy; develop supporting curricula and materials.
Participate in or facilitate discharge program meetings and internal or external work groups, use available resources, and identify service gaps.
May assign and supervise the work, time, and travel of Social Worker I and II employees and social work students; may participate in hiring and staff training.
Attend work regularly, follow assigned schedules, and perform other duties, including supporting disaster response, recovery, or Continuity of Operations activities.