Job Description
Job Summary Responsible for coordinating and managing discharge planning for patients admitted to the Withdrawal Management Unit (WMU) with substance use disorders and co-occurring medical and/or psychiatric conditions. Ensures safe, timely, and appropriate transitions to the next level of care based on ASAM criteria and individual patient needs. Essential Functions Works collaboratively with the interdisciplinary team and community providers to ensure continuity of care and successful recovery outcomes. Discharge Planning & Care Coordination Coordinate and implement individualized discharge plans for all WMU patients Identify appropriate next level of care (e.g., residential, PHP, IOP, outpatient, MAT) based on clinical needs and ASAM recommendations Schedule follow-up appointments prior to discharge with date, time, and provider documented Facilitate referrals to community resources including: Substance use treatment programs Mental health services Primary care providers Housing and social support services Continuity of Care Ensure smooth transitions by coordinating with receiving facilities and providers Transmit required clinical documentation to next level of care Provide patient education on Discharge plan Medication-assisted treatment (MAT) options Relapse prevention strategies Confirm patient understanding of follow-up instructions Interdisciplinary Collaboration Participate in daily multidisciplinary rounds Communicate discharge barriers and collaborate with team to resolve Work closely with Physicians Nursing staff Counselors Case management Length of Stay Awareness Support timely discharge planning aligned with patient progress Identify and address barriers early to prevent unnecessary delays Assist team in maintaining appropriate patient flow within the unit Documentation & Compliance Document all discharge planning activities in the EMR in accordance with: Hospital policy Regulatory requirements (Joint Commission, CMS, NJ DOH) Ensure documentation includes: Discharge plan Aftercare appointments Patient education Coordination efforts Other Duties The duties and responsibilities outlined above are not intended to be an exhaustive list. The employee may be required to perform additional tasks, responsibilities, or assignments needed to support the operations of the Withdrawal Management Unit and the organization. Duties may be modified or changed at any time, with or without notice, based on departmental and organizational needs. Minimum Education/Certifications Associate or Bachelor’s degree in social work, Counseling, or related field Preferred: CADC/LCADC or equivalent addiction certification Knowledge of ASAM Criteria and substance use treatment continuum Strong communication and coordination skills Minimum Work Experience Minimum 2 years behavioral health or substance use disorder experience At least 1 year in detox / withdrawal management or acute care setting preferred Position Type/Expected Hours of Work: Non-Exempt Physical Requirements Frequent walking and standing throughout the unit Ability to sit, bend, reach, and move between patient care areas Requires clear communication and observation skills Ability to work in a fast-paced environment and respond to patient needs promptly Working Conditions: Work is performed in an acute care hospital detox/withdrawal management unit with frequent exposure to patients experiencing: Active withdrawal symptoms (e.g., tremors, agitation, nausea, delirium risk) Substance intoxication and behavioral instability Co-occurring psychiatric conditions (anxiety, depression, psychosis)