Social Worker - Case Management

• Department: Case Management The Social Worker is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient’s resources and right to self-determination. The individual in this position has overall responsibility for ensuring that care is provided at the appropriate level of care based on medical necessity and to assess the patient for transition needs to promote timely throughput, safe discharge and prevent avoidable readmissions. Conducts complex psycho-social assessment and intervention to promote timely throughput, safe discharge and prevent avoidable readmissions. This position integrates national standards for case management scope of services including:
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is sequenced and provided at the appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers
• Participates in planning the social work component required in selected hospital programs
• Provides in-service education for staff
• Collaborate with community providers to develop educational resources appropriate for staff and patients/patient representatives This individual’s responsibility will include the following activities: a) care coordination, b) transition planning assessment and reassessment which may include complex psycho-social assessment and intervention, c) implementation or oversight of implementation of the transition/discharge plan, d) assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies, e) care coordination, f) implementation or oversight of implementation of the transition plan, g) leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review, h) making appropriate referrals to other departments, i ) communicating with patients and families about the plan of care, j) collaborating with physicians, office staff and ancillary departments, k) assuring patient education is completed to support post-acute needs ,l) timely complete and concise documentation in Case Management system, m ) maintenance of accurate patient demographic and insurance information, n) precepts new staff members and acts as a resource to all staff, o) facilitates TEMPO as needed, p) participates in department quality improvement initiatives, and q) other duties as assigned. Minimum Education / License / Certificates / Credentials: Master in Social Work (MSW). Minimum Experience/Skills: Minimum of two years acute hospital experience preferred.

include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem-solving skills and computer literacy. #LI-AJ1

Full time · Day shift