Monitors chronic care logs and caseload as needed to supplement referrals by staff.

Develops discharge planning referral criteria for intake medical screeners.

Consults routinely with medical providers on current caseload to identify patients meeting criteria for receiving pre-release health planning

Consults with the Armor behavioral health provider (including psychiatrist and licensed mental health professionals) on specific patients with complex needs that require supplemental coordination in addition to individual treatment plans or behavioral health referral plans upon release from custody

Participates in multidisciplinary planning in support specialized transitional programs dedicated to seriously or chronically ill patients (such as community based mental health teams and HIV Jail Linkage programs)