Social Worker BSW

About the Role

The Bachelor of Social Work (BSW) Case Manager plays a pivotal role in maintaining the quality of care patients receive during medical center hospitalization and post discharge while ensuring the organization is fully reimbursed. The BSW Case Manager must have a high level of expertise and skill to create highly effective strategies for short-term and long-term goals to prevent readmissions and address unpredictable situations. The role requires proficiency in planning, executing, and monitoring the effectiveness of care to ensure timely transition through the continuum of care.

The BSW Case Manager educates and consults with physicians and the healthcare team to achieve timely and appropriate levels of care, utilizing skills in conflict resolution, decision-making, and team building. The role operates in accordance with the care management process, using tools, standards, models, goals, objectives, and performance improvement concepts. The BSW Case Manager provides pertinent clinical data to outside agencies to ensure compliance with their requirements and represents the organization professionally.

The ability to analyze, evaluate, and distribute resources and educational information to ensure understanding across all educational levels is key. The social worker is responsible for assessing the patient’s psychosocial-spiritual needs, education, and discharge planning needs.

Responsibilities

• Provide social work intervention related to hospitalization, including crisis management, healthcare decision-making, illness adjustment, ethical/legal concerns, discharge planning, transitional care needs, child or elder abuse, domestic violence, competency issues, financial problems, compliance issues, substance abuse, mental illness, and other psychosocial barriers to maximizing health status (30%).
• Work with the healthcare team, patient, family, and/or significant others to transition the patient to the appropriate level/place of care. Advocate, mediate, and negotiate with an emphasis on self-determination to formulate a cohesive plan for maintaining health status, improving social supports, and moving the patient safely into less restrictive, less costly levels of care according to available resources (30%).
• Collaborate with physicians in competency/capacity determination, obtaining legal guardianship, involuntary psychiatric admission, adoptions, ethical concerns, etc. Complete and disseminate all necessary legal and clinical documentation as needed for resolution (20%).
• Collaborate with all members of the Care Management Team, including physicians, nurses, health information analysts, and others to provide information relating to admission, continued stay, discharge criteria, managed care, federal program regulations, reimbursement fundamentals, and regulatory standards on a daily basis (20%).
• Complete and document a standard social work psychosocial-spiritual assessment to eliminate barriers to treatment and discharge, increase patient/family satisfaction, and improve appropriate utilization of resources.
• Serve as the lead in obtaining financial and other resources for patients and families in need.
• Identify the need for and conduct family meetings, with or without the physician, to achieve understanding, comfort, decision-making, and other important outcomes such as discharge.
• Integrate relevant theories of family dynamics, crisis intervention, strengths-based, solution-focused, and meaning of illness into everyday casework.
• Summarize patient and family situations concisely, providing helpful guidance to non-social work staff about recommendations for actions and barriers to discharge.
• Facilitate discharge planning for patients, including extended care placements, other facility transfers, and home care arrangements in collaboration with the healthcare team.
• Actively participate in care coordination efforts to identify high-risk factors and respond appropriately, ensuring key information, next steps, and avoidable days are captured and documented.
• Participate in daily care coordination meetings and accept accountability for clinical outcomes facilitated by the Discharge Planning role.
• Maintain timely, clear, and concise documentation in all required systems.
• Provide pertinent clinical data to designated outside agencies to ensure compliance with their requirements.
• Ensure compliance with regulatory requirements and act as a resource/liaison to physicians and medical staff regarding all aspects of Case Management activities.
• During Care Coordination Rounds, communicate a patient-centered plan that is needs-based, appropriate to patient resources, timely, and addresses the risk of readmission.
• Build professional relationships with patients, families, facilities, and resources to address conflict resolution with positive outcomes.
• Complete all documentation and data entry requirements.
• Identify high-risk populations and address opportunities for intervention.
• Offer to help peers as needed and communicate teamwork, caring, and compassion.
• Provide excellent customer service to internal and external customers.
• Assume responsibility for professional development and education requirements for maintenance of professional licensure.
• Perform all other duties as assigned.

Requirements

• Credential: Bachelor of Social Work (BSW) required at time of hire.
• Limited License BSW (LLBSW) or Licensed BSW (LBSW) required. Limited License BSW employees must actively work toward full licensure, either as LBSW or toward their Licensed Master of Social Work (LMSW), including passing the licensing exam and completing 4,000 hours of supervised post-degree social work by a LMSW.
• Certification in Case Management preferred. Recommended to receive ACM certification after two years of experience.
• Bachelor's degree in Social Work (SOCWRK) required.

Qualifications

• Training and experience in casework principles, including diagnosis, assessment, crisis intervention, treatment, and transition planning.
• Techniques in individual, family, and group therapy.
• Awareness of community resources, public assistance, and entitlement programs to ensure transition to appropriate levels of care.
• Experience addressing issues relating to age and stage of development, special needs, and cultural patterns of patient populations.
• Knowledge of medical social work practices, processes, and procedures, typically acquired through three years of experience in a medical center, social agency, or community organization dealing with physical and/or mental health and/or welfare.
• Interpersonal skills to communicate successfully with individuals and groups at all levels.
• Adherence to the National Association of Social Workers’ Code of Ethics.
• Competency in Microsoft Windows.
• Membership in at least one professional organization (e.g., NASW, Society for Social Work Leadership in Health Care (SSWLHC)-MI Chapter, national SSWLHC) preferred.

Physical/Mental Requirements and Typical Working Conditions

• Exposure to stressful situations, including public contact, trauma, grief, and death.
• Able to wear personal protective equipment, including latex materials or appropriate substitutes.
• Ability to move freely about the facility with or without an assisted device.
• Overall vision and hearing necessary, with or without assisted devices.
• Frequently required to sit, stand, or walk for long periods; may require postural changes such as stooping, kneeling, or crouching.
• Some exposure to bloodborne pathogens and other potentially infectious materials; must follow bloodborne pathogen and TB testing requirements.
• Ability to handle multiple tasks, work well with others, work independently, maintain regular and predictable attendance, and stay awake.
• Overall dexterity required, including handling, reaching, grasping, fingering, and feeling; may require repetition of these movements.
• Physical demand level: Sedentary. Must occasionally (0-33% of the workday) lift or carry 0-10 lbs.