Case Manager Social Worker

About the Role

The Social Worker provides services to patients, family members, and/or significant others to help them deal with adjustment to illness, understanding and accepting diagnoses, prognoses, or treatment of new or recurrent disease. The role involves counseling and intervention in cases of suspected abuse or neglect and adoption, as well as coordination of complex discharge planning, including placement.

Responsibilities

• Uses and develops the social work process of assessment, planning, implementation, and evaluation.
• Collects and assesses data related to individual healthcare needs, including past medical history, current health status, treatment, necessity/appropriateness for services, and follow-up.
• Provides counseling to enable patients, family members, and significant others to utilize resources and strengths for necessary adjustments due to illness.
• Actively participates in multidisciplinary rounds and communicates daily with RN Case Managers and RNs to identify appropriate referrals.
• Convenes family meetings to provide clarity on the patient’s status and facilitate informed decision-making.
• Formulates discharge plans by collaborating with the patient/family, healthcare team members, and outside agencies, particularly for complex cases such as oncology diagnoses, difficult family dynamics, hospice, end-of-life issues, and placement challenges.
• Assesses and reports suspected child or adult neglect/abuse to the appropriate protective services and coordinates safe care plans with physicians, nurse managers, and case managers.
• Coordinates with domestic violence service agencies for counseling or shelter placement when necessary.
• Documents ongoing communication in the patient’s electronic database for all individuals responsible for the continuum of care or regulatory issues.
• Conducts support and education groups to assist in the adjustment process, including facilitating time-limited or ongoing group processes for family members.
• Handles community calls and visits, and provides on-call coverage for social work interventions on Sundays and holidays, including directing urgent needs for DME or HHC if no Case Manager is available.
• Develops and maintains effective communication skills for all interactions and adapts communication styles as needed.
• Participates in daily team meetings and the educational process for co-workers, orientees, and other departments.
• Adheres to safety and legal requirements at hospital and departmental levels.
• Assists in planning and implementing departmental quality management and disaster response activities.
• Complies with HIPAA standards and promotes a positive, effective practice environment.
• Accepts accountability for professional growth and development, remaining current on trends in social work practice.
• Serves on committees, task forces, and work groups at the staff/department level.