Drug/Alcohol Case Manager WES Health SystemDrug/Alcohol Case ManagerPhiladelphia, PA$42,200While performing the duties of this job, the employee is occasionally required to stand; walk; sit; use hands to finger, handle, or feel objects, tools or controls; reach with hands and arms; climb stairs; balance; stoop, kneel, crouch or crawl; talk or hear; taste or smell. Bachelors Degree or Masters Degree in Human/Services/Social Sciences or related field with a minimum of 2 years experience in substance abuse counseling; or any combination of experience, education or training that would provide the level of knowledge, skill and ability required.
RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus) Temple University Health SystemRN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)Philadelphia, PAPennsylvania-Philadelphia'',''Pennsylvania-Philadelphia'',''Nursing Admin & Management'',''Nursing Admin & Management'',''Full-time'',''Full-time'',''Day Job'',''Day Job'',''Regular'',''Regular'',''false'',''406091'',''406091'',''true'',''406091'',''false'',''Submission for the position: RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus) - (Job Number: 263840)'',''false'',''406091'',''false'',''true''. ''406091'',''true'',''406091'',''false'',''Submission for the position: RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus) - (Job Number: 263840)'',''false'',''406091'',''false'',''true'',''RN Case Manager - Utilization Review (Temple Hospital Jeanes Campus)'',''263840'',''!*!
Senior Habilitation Manager Bayada Home Health Care, Inc.Senior Habilitation ManagerPhiladelphia, PACollaborate with clients, families, Case Managers, Habilitation Technicians, and other care team members to identify, implement, and evaluate individualized goals and service needs. You will work closely with clients, families, Case Managers, Care Coordinators, and interdisciplinary teams to ensure services align with each individual''s goals and needs.
Workers Comp Clinical State Manager IvyrehabWorkers Comp Clinical State ManagerPhiladelphia, PennsylvaniaRemoteDrive Workers’ Comp KPI Metrics, including but not limited to Workers’ Comp Visits, New Patients, LOS, SFQ, coding accuracy for PT/OT and Work conditioning payor mix, functional capacity evaluations, SSG planning, and other industrial specialty services. Responsible for implementation, monitoring and reporting on results of assigned special projects nurse case manager CEUs, social media blogs, workers’ comp networking/conference activities, and integration/companywide trainings.
ABA Counselor- RTF Department Melmark, IncABA Counselor- RTF DepartmentPAAccurately collects data on all targeted behaviors for acceleration and declaration on assigned individual(s) as indicated in Behavior Support Plan and/or Protocol Summary Responds appropriately during crisis (i.e., utilizing only approved crisis management techniques, being calm and composed, or acting quickly to protect others) as indicated in the crisis prevention training curriculum or each individuals Protocol Summary or Behavior Support Plan (BSP). Schedule and Salary Information Schedule: 3 weekday shifts 3pm-11pm and 1 weekend shift 7am-11pm Bachelors Degree Starting Rate: $25.00 (+) based on years of direct population experience Starting Rate with a minimum of 50 verified college credits (no bachelors): $20.00 (+) based on years of direct population experience Requirements Bachelors degree strongly preferred; Minimum requirement of 50 College Credits.
Registered Nurse RN Case Manager DaVita IncRegistered Nurse RN Case ManagerWest Grove, PAIn lieu of case management experience, 3 or more years of experience assessing patient needs, developing and managing individualized care plans, coordinating services across interdisciplinary teams, and supporting patients through complex healthcare transitions is required. Our more than 600 dedicated nurses, care coordinators, nurse practitioners (NPs) and business professionals integrate and manage care for more than 20,000 patients with late-stage chronic kidney disease (CKD) and end stage renal disease (ESRD) across the US each month.
Mental Health Case Manager PROMISE Volunteers of America Delaware ValleyMental Health Case Manager PROMISECamden, NJPart timeCredentials/Abilities: The employee in this position must have a Master’s Degree preferably in Social Work (MSW), however, a Master’s degree in Counseling or another Human Services related field may be considered. Additional job-related skills include: working with addictive personalities; a basic understanding of human behavior; and utilizing group dynamics to address special needs populations.
PA - Philadelphia - RN Case Manager Abby CarePA - Philadelphia - RN Case ManagerPhiladelphia, PennsylvaniaThe RN Case Manager will work closely with patients, families, Primary Care Physicians (PCPs), therapy providers, and internal support teams to ensure optimal patient outcomes. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system.
Philly - RN Case Manager Abby CarePhilly - RN Case ManagerPhiladelphia, PennsylvaniaThe RN Case Manager will work closely with patients, families, Primary Care Physicians (PCPs), therapy providers, and internal support teams to ensure optimal patient outcomes. Driven to Redefine What’s Possible We are here to make healthcare better, which means asking hard questions, challenging outdated systems, and finding smarter, more compassionate ways to deliver care.
Case Coordinator JAMS LLCCase CoordinatorPhiladelphia, PACollaborates with Panelist(s) to develop and administer their ADR practice including coordinating and scheduling of conference calls, pre-hearing preparation calls, moderating, customer service, interacting with clients, and hearings. Provides continued support to Case Manager(s) and Panelists, as well as performs a wide variety of administrative, coordination, and program support activities.
Case Coordinator JAMS, Inc.Case CoordinatorPhiladelphia, PennsylvaniaFull timeCollaborates with Panelist(s) to develop and administer their ADR practice including coordinating and scheduling of conference calls, pre-hearing preparation calls, moderating, customer service, interacting with clients, and hearings. Provides continued support to Case Manager(s) and Panelists, as well as performs a wide variety of administrative, coordination, and program support activities.
NewRN Case Manager- 40/hrs, Day Shifts (Temple Hospital) Temple HealthRN Case Manager- 40/hrs, Day Shifts (Temple Hospital)Philadelphia, PAMonitors the level of care, initiating evidence based protocols and order sets according to the patients' admission diagnosis, influencing the progression of care, facilitating the patients' navigation through the acute care episode, and proposes an appropriate transition plan within 48 hours of admission. Temple Health consists of Temple University Hospital (TUH), Fox Chase Cancer Center, TUH-Jeanes Campus, TUH-Episcopal Campus, TUH-Northeastern Campus, Temple Physicians, Inc., and Temple Transport Team.
NewSenior Case Manager KINTOCK GROUP INC, THESenior Case ManagerPhiladelphia, PAGeneral Information: Under the supervision of the Program Director, in addition to managing a modified case load, this position provides supervision for other case managers in preparing case histories and records parole and furlough planning, referrals, and other related administrative duties. Must be able to establish and maintain relationships with community treatment facilities and other resources essential to case management; Maintain appropriate clearance to service respective clients, and.
Care Manager Good Shepherd RehabilitationCare ManagerPhiladelphia, PAJOB SUMMARY The case manager is responsible for the development of a comprehensive and goal oriented plan of care as it relates to providing ongoing psychosocial assessment, screening for potential needs, discharge planning, and communication with the clinical team and professional staff; Acting as a liaison between the patient, the clinical team, and utilization manager; the management of individual caseloads of patients through interaction with families, conducting weekly interdisciplinary team meetings and assisting patients and families with discharge planning; supporting the case management department needs by functioning as a utilization manager as needed. Education Bachelors Degree in Nursing or Social Work required Masters Degree preferred Work Experience 3-5 years of relevant case management experience required Previous experience in utilization review preferred Licenses / Certifications Registered Nurse license required OR LSW / LCSW, and/or Certified Case Manager (CCM) preferred.
Registered Nurse/Case Manager IMCS Group IncRegistered Nurse/Case ManagerPaoli, PASpecial Requirements: Return Staff: if candidates have previously worked at any Main Line location, please include location and dates worked with submission. Weekend Req: no weekend but if they'd like to work weekends that is a possibility!
Life Skills Case Manager (up to $3,200/month) Delta-T Group Inc.Life Skills Case Manager (up to $3,200/month)Philadelphia, PennsylvaniaDelta-T Group's mission is to provide cost-effective, reliable referrals, and innovative staffing solutions, for the social services, behavioral health, allied health and special education fields, for the betterment of independent behavioral health professionals seeking new opportunities and those needing care and support. Contract Contact: Contract Submit PA BehavOffice Email: PABehavContracts@deltatg.comOffice Phone: 800-251-8501Office Address: 950 E Haverford Road, Suite 200, Bryn Mawr, PA 19010.
Forensic Case Manager Delta-T Group Inc.Forensic Case ManagerMIDDLE CITY EAST, PennsylvaniaDelta-T Group's mission is to provide cost-effective, reliable referrals, and innovative staffing solutions, for the social services, behavioral health, allied health and special education fields, for the betterment of independent behavioral health professionals seeking new opportunities and those needing care and support. Contract Contact: Contract Submit PA BehavOffice Email: PABehavContracts@deltatg.comOffice Phone: 800-251-8501Office Address: 950 E Haverford Road, Suite 200, Bryn Mawr, PA 19010.
Short Term Disability/Absence Claims Case Manager I The Guardian Life Insurance Company of AmericaShort Term Disability/Absence Claims Case Manager IPAThis preliminary screening may be used to help identify applicant materials and resumes relative to their indication that the applicant meets the requirements for the specific job for which they are applying, as specified in the listing posted on Guardian's jobs website (Careers at Guardian at https://www.guardianlife.com/careers Assess claim when other sources of income are received (e.g., social security, state disability, etc.,) to ensure accurate offsets are applied and recalculate benefits, as needed, to determine under/overpayments.
Case Manager - IBHS Program Kaleidoscope ABA Therapy ServicesCase Manager - IBHS ProgramBryn Mawr, PennsylvaniaCompany: Kaleidoscope Family Solutions ABA, IncContract Contact: HQ CareersOffice Email: Recruit@kfsaba.orgOffice Phone: 877-ABA-0399Office Address: 950 E Haverford Road, Suite 100A, Bryn Mawr, PA 19010. This role's primary responsibility is to manage the health and proactive relationship with children, families, and school communities serviced under Kaleidoscope ABA IBHS program.
Case Manager-Mcc Public Health Management CorporationCase Manager-MccPhiladelphia, PAJob overview: The Healthy Start Fatherhood Initiative Case Manager (HSFICM) is responsible for comprehensive case management within the Healthy Start Fatherhood Initiative (HSFI) parenting education program and related fatherhood initiatives. Stay current with best practices in parenting education, maternal/child health, financial empowerment, racial disparities, infant development, mental health, trauma-informed care, and related fields.
Residential Nurse Case Manager BancroftResidential Nurse Case ManagerCherry Hill, NJ$81,000–$93,000 / yearServes as key liaison, advocate, and a resource of information regarding both routine and special healthcare needs to support a comprehensive care plan for each person: o Facilitates a team approach to the continued provision of quality care to individual supported through interaction, communication, and collaboration with family members, discipline-specific clinical staff, primary physicians, healthcare providers, pharmacists, Nursing Department management/staff, Medical Director, program management/staff, School staff members, external case workers, state and federal regulatory agencies, insurance companies, hospitals and rehabilitation facilities, etc., to attain and maintain the provision of quality care for persons served and assist in the removal or modification of reported health related barriers; Communicates effectively professionally and respectively. Department of Education Administrative Code and Amendments, Commission on Accreditation of Rehabilitation Facilities (CARF), Joint Commission for the Accreditation of Healthcare Organization (JCAHO) and Division of Children and Family Services (DCF) where applicable, Individual Program Plan (IPP), Health Insurance Portability & Accountability Act (HIPAA), and established Bancroft policies and procedures, provides various nursing care management oversight and identifies, assess, and improve and maintain the quality of life and healthcare to persons served.
NewRequisition Program Associate BancroftRequisition Program AssociateCherry Hill, NJKeywords: Developmental Disabilities, Intellectual Disabilities, DD, Autism, Direct Support, Direct Care, Community Based, Mental Health Technician, Certified Nursing Assistant, CNA, Patient Care Assistant, PCA, Home Health Aide, Residential Counselor, Caregiver, Companion, Applied Behavior Analysis, ABA, Neurobehavioral, Psychology, Social Services. Direct Support Professionals provide assistance with daily living activities that may include, but are not limited to, personal hygiene, social awareness, meal preparation, money management, and housekeeping.
Special Education Lead Case Manager - 2026/2027 School Year Mastery SchoolsSpecial Education Lead Case Manager - 2026/2027 School YearPhiladelphia, PA$94,250–$105,560 / yearAdditionally, the Lead Case Manager provides mentorship to students and guidance to staff to ensure the effective implementation of specialized services across all academic settings. Minimum of three (3) years of experience working with special education students and collaborating with families, teachers, and external service providers to support student success.
Family Based Case Manager MerakeyFamily Based Case ManagerKennett Square, PAProvides treatment services to families including skills training and education designed to enable families to care for their mentally ill or emotionally disturbed children at home. Travels to client's homes, other agencies, and community resources for purpose of arranging and providing community and home-based services for children, adolescents, and families.
Case Manager-MCC Public Health Management CorpCase Manager-MCCPhiladelphia, PAJob overview: The Healthy Start Fatherhood Initiative Case Manager (HSFICM) is responsible for comprehensive case management within the Healthy Start Fatherhood Initiative (HSFI) parenting education program and related fatherhood initiatives. Stay current with best practices in parenting education, maternal/child health, financial empowerment, racial disparities, infant development, mental health, trauma-informed care, and related fields.
NewSenior Case Manager The Kintock GroupSenior Case ManagerPhiladelphia, PAUnder the supervision of the Program Director, in addition to managing a modified case load, this position provides supervision for other case managers in preparing case histories and records parole and furlough planning, referrals, and other related administrative duties. · Must be able to establish and maintain relationships with community treatment facilities and other resources essential to case management; · Maintain appropriate clearance to service respective clients, and.
Truancy Case Managers - Philadelphia CORATruancy Case Managers - PhiladelphiaPhiladelphia, PennsylvaniaIn addition, as a Truancy Case Manager your duties will include: Engaging clients (students), families and other relevant individuals in a collaborative relationship that will enhance the potential for the client’s completion of service with positive outcomes; caseload size will vary. Collecting/monitoring required school data and client satisfaction materials in the prescribed format; communicating with DHS and the Court and, within privacy rights protections, with school personnel and other service providers regarding service status and outcomes for RTC-involved students and families.
Registered Nurse-Rn Case Manager - St. Mary Home Care Trinity Health CorporationRegistered Nurse-Rn Case Manager - St. Mary Home CareNewtown, PAA Catholic-based, non-profit organization, we serve patients and their loved ones with home care (skilled nursing, physical/occupational and speech therapy and medical social work), palliative care, hospice and bereavement services. We have a pioneering care model with Home Care Connect, our integrated virtual care program that helps patients avoid preventable ER visits and hospitalizations.
Transitional Case Manager, Weekday - PRN Cooper University HospitalTransitional Case Manager, Weekday - PRNCamden, New JerseyPer diemShort Description: Provides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Transitional Case Mgr weekend- PRN Cooper University HospitalTransitional Case Mgr weekend- PRNCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Coordinates care authorization process with insurersCoordinates specific details of patient’s hospitalization with Utilization Management department to ensure appropriate admission status.
Transitional Case Manager PRN - Weekday Cooper University HospitalTransitional Case Manager PRN - WeekdayCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Transitional Case Manager Cooper University HospitalTransitional Case ManagerCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Transitional Case Mgr Weekend - PRN Cooper University HospitalTransitional Case Mgr Weekend - PRNCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Case Manager, Rare Endocrinology & Rare Tumor (RERT) Team (Pacific Time Zone) Alexion Pharmaceuticals IncCase Manager, Rare Endocrinology & Rare Tumor (RERT) Team (Pacific Time Zone)Wilmington, DEDevelop compliant and collaborative professional relationships with all relevant internal and external customers including but not limited to Field Reimbursement Managers, Regional Account Managers, Customer Operations Representatives, medical accounts, Funding Specialists, Access Specialists, Specialty Pharmacies, site of care staff, and office coordinators. Effectively escalate vendor service provider issues which may impact patients by informing appropriate internal stakeholders and taking needed actions to resolve issues in a timely manner.
Emergency Housing Case Management Supervisor Public Health Management CorporationEmergency Housing Case Management SupervisorPhiladelphia, PAThe ideal candidate is a collaborative, solutions-oriented leader who can work effectively with emergency housing participants, case management staff, housing navigators, funders, and external stakeholders to achieve strong program outcomes. Under the supervision of the Director of Housing Services, the Emergency Housing (EH) Case Manager Supervisor leads and manages a team of case managers in an Emergency Housing Program.
Program Associate BancroftProgram AssociateCherry Hill, NJ$19.06–$19.44 / hourKeywords: Developmental Disabilities, Intellectual Disabilities, DD, Autism, Direct Support, Direct Care, Community Based, Mental Health Technician, Certified Nursing Assistant, CNA, Patient Care Assistant, PCA, Home Health Aide, Residential Counselor, Caregiver, Companion, Applied Behavior Analysis, ABA, Neurobehavioral, Psychology, Social Services. Direct Support Professionals provide assistance with daily living activities that may include, but are not limited to, personal hygiene, social awareness, meal preparation, money management, and housekeeping.
Program Associate (DSP) BancroftProgram Associate (DSP)Wilmington, DE$18.21–$18.58 / hourKeywords: Developmental Disabilities, Intellectual Disabilities, DD, Autism, Direct Support, Direct Care, Community Based, Mental Health Technician, Certified Nursing Assistant, CNA, Patient Care Assistant, PCA, Home Health Aide, Residential Counselor, Caregiver, Companion, Applied Behavior Analysis, ABA, Neurobehavioral, Psychology, Social Services. Direct Support Professionals provide assistance with daily living activities that may include, but are not limited to, personal hygiene, social awareness, meal preparation, money management, and housekeeping.
Case Manager University Health Services IncCase ManagerPHILADELPHIA, PAThe Case Manager: provides quality case management and qualified professional support and services to inpatient social workers as assigned; works with local agency and service providers to facilitate sending and receiving collateral information, treatment referrals, and ongoing communications to support patient's successful inpatient treatment and discharge. About Universal Health Services One of the nation's largest and most respected providers of hospital and healthcare services, Universal Health Services, Inc. (NYSE: UHS) has built an impressive record of achievement and performance, growing since its inception into a Fortune 500 corporation.
Group Homes Program Manager (IDD Population) (equivalent to Residential Director) RHA Health ServicesGroup Homes Program Manager (IDD Population) (equivalent to Residential Director)Cherry Hill, New Jersey$65,000–$75,000 / yearRegular If you are a positive and personable individual looking for a satisfying and fun opportunity to make a real difference in the lives of people with intellectual, developmental disabilities, and people facing mental health, and substance use challenges, join our team at RHA Health Services! Must be able to demonstrate proficiency in CPR from the floor level requiring to work on hands, knees, bending, standing and lifting.
Correctional Treatment Specialist (Case Manager) U.S. Department of JusticeCorrectional Treatment Specialist (Case Manager)Philadelphia, PA$55,361–$79,699 / yearEvaluation of Experience - Experience must have been gained in (1) casework in a correctional institution or in another criminal justice setting; (2) counseling in any setting, provided it required diagnostic or treatment planning skills to achieve specific social or occupational goals; or (3) work treating persons in need of social rehabilitation. Evaluation of Education - Courses, such as sociology, correctional administration, criminal justice, government/political science, psychology, social work, counseling, and other related social or behavioral science courses may be used to satisfy the 24-semester-hour requirement.
Lead Counselor – Licensed Pyramid HealthcareLead Counselor – LicensedLansdale, PAThis role combines direct clinical care with leadership responsibilities, supporting both clients and fellow clinicians while helping ensure the delivery of high-quality, evidence-based treatment. Through our specialized programs—Rehab After Work, The Light Program, and Seeds of Hope—we provide compassionate, evidence-based care to adults and adolescents facing mental health and co-occurring disorders.
Mental Health Case Manager Child & Family Focus, Inc.Mental Health Case ManagerBroomall, PAResponsibilities include providing case management, service planning, and coordination of services with other agency providers to meet the client’s needs along with supportive counseling. The Blended Case Manager will also provide advocacy in order to help consumers set and achieve recovery goals and empower consumers to increase self-advocacy.
PA - Pittsburgh - RN Case Manager Abby CarePA - Pittsburgh - RN Case ManagerPhiladelphia, PennsylvaniaIn this high-agency role, you will hold high-level deliverables centered on managing patient care plans, providing critical clinical oversight to Home Health Aides (HHAs) and Certified Nursing Assistants (CNAs), and collaborating closely with families, primary care physicians, and therapy providers to ensure optimal, compassionate patient outcomes. We believe families are the largest untapped caregiving workforce in America, and that technology can help them deliver better care while driving stronger outcomes and greater transparency across the healthcare system.
Family Based Case Manager - Part Time Child & Family Focus, Inc.Family Based Case Manager - Part TimeAudubon, PAPart timeChild and Family Focus's Family Based Services assign a team of one Master level clinician and one Bachelor level case manager to work closely with clients in the home, school and community to address the child’s emotional struggles as well as the larger systemic issues contributing to troublesome behavior. Child and Family Focus has a part-time, Bachelor's level Case Manager position available in Montgomery County that give our teams autonomy and flexibility in a clinically rich environment, with the support of experienced leaders.
Emergency Housing Case Management Supervisor Public Health Management CorpEmergency Housing Case Management SupervisorPhiladelphia, PAThe ideal candidate is a collaborative, solutions-oriented leader who can work effectively with emergency housing participants, case management staff, housing navigators, funders, and external stakeholders to achieve strong program outcomes. Under the supervision of the Director of Housing Services, the Emergency Housing (EH) Case Manager Supervisor leads and manages a team of case managers in an Emergency Housing Program.
Nursing Case Manager Community OptionsNursing Case ManagerKing Of Prussia, PennsylvaniaWe are seeking a Full-Time Nurse Case Manager in King of Prussia, PA to deliver care to individuals with disabilities in a home health setting, utilizing the nursing process of assessment, planning intervention, implementation, and evaluation. Provide special instructions to resident and home staff related to medical diagnosis, allergies, diet, etc., and is available for ongoing consultation to staff regarding medical problems and healthcare.
Transitional Case Mgr Weekend PRN Cooper University Health CareTransitional Case Mgr Weekend PRNCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Our extraordinary professionals are continuously discovering clinical innovations and enhanced access to the most up-to-date facilities, equipment, technologies and research protocols.
Transitional Case Manager, Weekday PRN Cooper University Health CareTransitional Case Manager, Weekday PRNCamden, NJProvides psychosocial assessments, crisis intervention, resources referrals, to facilitate discharge plans, and/or adjustment to illness, and complex discharge planning for patients and their families. Coordinates care authorization process with insurersCoordinates specific details of patient's hospitalization with Utilization Management department to ensure appropriate admission status.
Childrens Behavioral Health Case Manager MerakeyChildrens Behavioral Health Case ManagerWilmington, DEMonitor record keeping, compliance and authorized units remaining, ensures that client charts are up-to-date and include all necessary documentation, including documentation of significant incidents within 24 hours as needed (incident reports). Coordinate referrals for client specific discharge planning; ensuring that the family actively participates in creating a multi-faceted discharge plan; one which represents the family's choice for service providers, and community resources.