Social Worker - Care Manager - St. Rita's Medical Center

About the role

As a faith-based and patient-focused organization, Mercy Health exists to enhance the health and well-being of all people in mind, body and spirit through exceptional patient care. Success in this goal requires a culture of compassion, collaboration, excellence and respect. Mercy Health seeks people that are committed to our values of compassion, human dignity, integrity, service and stewardship to create an environment where associates want to work and help communities thrive.

The Social Worker Care Manager is responsible for providing appropriate interventions and discharge planning services to patients and families and facilitates a smooth transition for the patient throughout the continuum of care by accessing hospital, community, and governmental resources. They also provide clinical supervision to peers, Social Workers, and students. This is a full-time position (36 hours per week) at St. Rita's Medical Center.

Responsibilities

• Identifies and prioritizes patients in need of social services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors.
• Plans with the patient, caregivers and members of the healthcare team to maximize health care responses, quality and cost-effective outcomes.
• Monitors and revises the plan as indicated when patient condition changes.
• Completes all necessary documentation.
• Maintains clear, concise, and timely documentation in the patient record to reflect the needs of the patients. Documentation will reflect plan of care to address post hospital care needs and resources and evidence of patient, family, or caregiver involvement in planning.
• Ensures patient’s and caregiver’s treatment goals and preferences are incorporated into the transition of care planning and communicated to the multidisciplinary team.
• Follows standardized practices and processes related to Advance Care Planning, Length of Stay management and readmission prevention.
• Supports denial prevention related to medical necessity through addressing/removing barriers to progression of care and participating in Interdisciplinary Discharge Rounds.
• Supports and promotes assertive, proactive care for patients, assisting in removing barriers related to achieving timely testing and treatment.
• Ensures resources are utilized appropriately and offers alternatives to acute care to the