Care Manager - Social Worker

About the role

The Social Worker in the Continuing Care Department is an integral member of a hospital patient’s care team, responsible for assessing and intervening to ensure the effective continuation of a patient’s care after discharge from the hospital. The social worker will be assigned to a unit or units, which may include medical, surgical, intensive care, OB/Maternity, pediatric, and/or Emergency Department, and will work closely with physicians, nurses, and other practitioners on the assigned unit.

Responsibilities

• Interview hospital patients and family members/caregivers
• Facilitate family meetings to identify needs and develop continuing care plans
• Assess psychosocial needs
• Counsel patients and family members to promote effective coping and treatment plan compliance
• Assess knowledge deficits
• Educate patients and family members about community resources, rights and responsibilities, advance directives, end-of-life care issues, health insurance, and navigating the health care system
• Coordinate complex care plans involving a wide range of internal and external services including home health, social services, rehabilitation, and mental health providers
• Advocate for patients to receive needed resources and services
• Function as part of a multidisciplinary team
• Participate in department and hospital initiatives related to process improvement and patient care as opportunities arise

Requirements

• Master’s in Social Work; equivalent experience or certification considered
• Licensed in Maryland as a LMSW or LCSW
• 1-3 years prior social work experience in a hospital, nursing care facility or other health care setting, preferably doing discharge planning work

Skills

• Cultural competency and willingness to work with patients of many different racial, national, ethnic, and religious backgrounds as well as different age groups and socioeconomic statuses
• Basic computer skills (electronic medical record training is provided)
• Interview skills including active listening, open-ended questioning, and empathy
• Assessment skills to quickly develop thorough assessments and care plans
• Skill in, or willingness to learn, counseling and motivational interviewing techniques
• Willingness to engage with difficult or noncompliant patients or family members; willingness to discuss topics such as end-of-life care or substance abuse
• Ability to self-direct and negotiate competing priorities
• Ability to develop a wide-ranging working knowledge of services, referral processes and criteria, medical terms and needs, etc. (training is provided)
• Ability to work in a fast-paced environment; desire to engage with change processes and work closely with multi-disciplinary teams
• Knowledge and understanding of patient and workforce safety as it relates to job duties
• Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable

Pay

Pay Range: $58,488.99 - $93,582.39. Final salary offer will be based on the candidate's qualifications, education, experience and alignment with our organizational needs.