Resource Specialist-Onsite One Hundred Oaks

Discover Vanderbilt Health: With eight hospitals and over 180 clinics, we are the region’s largest comprehensive academic health system. Vanderbilt Health has a long tradition of providing world-class care to the people of the Mid-South, living out our mission of moving medicine forward through preeminent programs in patient care, education and research. Here you’ll find a spirit of collaboration and a supportive community where your expertise is valued, your knowledge expanded and your uniqueness celebrated.

About the Role

The Social Worker will evaluate the psychosocial needs of patients and family support systems and will coordinate appropriate discharge plans for identified patient populations. The Social Worker acts as a liaison between the facility and resources external to the organization. He/she will facilitate implementing timely discharge plans and facilitate follow-up to anticipated post-acute interventions identified in the plan of care. The Social Worker will provide crisis intervention and support. The Social Worker will assist the Resource Manager in facilitating patient movement across the continuum of care and will identify and track barriers to patient throughput.

Responsibilities

• Performs a comprehensive assessment of psychosocial needs of assigned patients
• Assesses patients discharge needs and facilitates the provision of services necessary to meet identified needs
• Evaluates suspected abuse and neglect referrals and makes official reports
• Develops an individual plan of care for recurring patients to include education related to accessing healthcare services at the appropriate level of care
• Provides education to the under-resourced patient/family of potential and available resources
• In collaboration with the interdisciplinary team, develops, implements, evaluates, revises as needed, a discharge plan to include identified psychosocial and discharge needs
• Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
• Participates with the interdisciplinary team to ensure psychosocial and discharge needs are addressed
• Acts as a liaison through effective and professional communications between and with physicians, patient/family, hospital staff, and outside agencies
• Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives
• Makes appropriate referrals, after collaboration with the Case Manager, to third party payer disease and case management programs for recurring patients and patients with chronic disease states
• Facilitates patient throughput with an ongoing focus on quality outcomes and an efficient transition between levels of care
• Tracks and trends barriers to care, makes recommendations and develops action plans to improve processes and systems
• Provides psychosocial support to patients and families through crisis intervention
• Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
• Acts as an advocate for identified needs and makes appropriate referrals
• Acts as a liaison between the facility and community resources to enhance community outreach coordination
• Tracks and trends variances barriers related to access to care
• Adheres to established policy and procedure and standard of care

Core Capabilities

• Supporting Colleagues:
  • Develops Self and Others: Invests time, energy, and enthusiasm in developing self/others to help improve performance and gain knowledge in new areas.
  • Builds and Maintains Relationships: Maintains regular contact with key colleagues and stakeholders using formal and informal opportunities to expand and strengthen relationships.
  • Communicates Effectively: Recognizes group interactions and modifies one's own communication style to suit different situations and audiences.
• Delivering Excellent Services:
  • Serves Others with Compassion: Seeks to understand current and future needs of relevant stakeholders and customizes services to better address them.
  • Solves Complex Problems: Approaches problems from different angles; identifies new possibilities to interpret opportunities and develop concrete solutions.
  • Offers Meaningful Advice and Support: Provides ongoing support and coaching in a constructive manner to increase employees' effectiveness.
• Ensuring High Quality:
  • Performs Excellent Work: Engages regularly in formal and informal dialogue about quality; directly addresses quality issues promptly.
  • Ensures Continuous Improvement: Applies various learning experiences by looking beyond symptoms to uncover underlying causes of problems and identifies ways to resolve them.
  • Fulfills Safety and Regulatory Requirements: Understands all aspects of providing a safe environment and performs routine safety checks to prevent safety hazards from occurring.
• Managing Resources Effectively:
  • Demonstrates Accountability: Demonstrates a sense of ownership, focusing on and driving critical issues to closure.
  • Stewards Organizational Resources: Applies understanding of the departmental work to effectively manage resources for a department/area.
  • Makes Data Driven Decisions: Demonstrates strong understanding of the information or data to identify and elevate opportunities.
• Fostering Innovation:
  • Generates New Ideas: Proactively identifies new ideas/opportunities from multiple sources or methods to improve processes beyond conventional approaches.
  • Applies Technology: Demonstrates an enthusiasm for learning new technologies, tools, and procedures to address short-term challenges.
  • Adapts to Change: Views difficult situations and/or problems as opportunities for improvement; actively embraces change instead of emphasizing negative elements.

Requirements

• Bachelor's degree in Social Work or related field
• 1 year of relevant work experience

Benefits

This role offers the opportunity to make a meaningful impact within Vanderbilt Health, supported by a comprehensive benefits package which may include health, disability, retirement and/or wellness offerings to enhance your well-being and professional growth.