Social Worker Case Manager - Per Diem

About the role

The SW Case Manager is responsible for working with patients, families and interdisciplinary care team members with the overall goal of developing transitional care plans that are patient-centered and are formulated in a manner that respects patients’ individual needs, values and goals and are developed in alignment with available resources. The role requires collaboration with the RN UR/Case Manager and other members of the care team, such as physicians, nurses, pharmacy, therapy, Primary Care social workers, etc.

Responsibilities

• Develops and coordinates inpatient discharge plans for patients who are considered at risk for adverse outcomes (i.e., such as readmission, medication error, falls, etc.) as determined by the interdisciplinary care team and in collaboration with the RN UR/ Case Manager and other members of the care team, such as physicians, nurses, pharmacy, therapy, Primary Care social workers, etc.
• Affords assessments to all inpatients including those on Birthing Suite and Med Surg Unit to determine the need for services post-discharge services as soon after admission as possible (preferably within one day of admission with the exception of weekends/holidays).
• Collaborates with the interdisciplinary team and the patient and family, as appropriate to develop a plan.
• Makes referrals to health care providers, nursing facilities and agencies to transition care to the post- discharge.
• Documents all discharge planning activities in the medical record.
• Arranges for family meetings, as appropriate.
• Completes documentation as required by nursing facilities, by DHHS and others to facilitate the patient’s discharge to other care settings.
• Aids in identifying cost savings for treatment consistent with payor requirements and consistent with patient financial resources to mitigate cost of care (i.e., medications; equipment; post-acute providers).
• Provides information and advice to outpatient areas, such as the Emergency Department and other areas where patients are identified to be in need of services, such as skilled care or home care.
• When providing outpatient advice, the SW Social Worker will consult with primary care social workers to determine whether patients are already under the care of MHP so that appropriate hand-offs can be made.
• Participates in internal and external quality improvement activities, reports adverse events and adheres to safety practices, reports accidents/hazards and maintains equipment as outlined in hospital policies.

Requirements

• Education: A Bachelors degree in social work from a college accredited by the Council on Social Work Education is required with preference given to a candidate that is certified and/or is working towards a Master’s degree.
• Experience: 1-2 years experience in hospital setting required.
• Required Skills: Must have excellent interpersonal skills and the ability to communicate effectively through various means with a variety of individuals, including physicians, patients, families of patients, the public and co-workers. Good overall clinical skills required. Demonstrated ability to function well as a member of a multi disciplinary team required. Ability to represent the program well in interactions both inside and outside the hospital is necessary.

Additional Competencies And Skills

• Candidates may acquire these skills through on-the-job training* Proficiency with Microsoft products such as Word, Excel, PowerPoint

Working Hours

This is a per diem position.

Pay

Competitive salary based on experience.