Facility: Nexus Children’s Hospital – Shenandoah About Nexus Children’s Hospital – Shenandoah Nexus Children’s Hospital – Shenandoah is a 50-bed specialty inpatient hospital providing advanced, structured care for children and adults with complex medical and behavioral health needs. Our campus includes a 16-bed ICU/Medical-Surgical Unit for high-acuity medical care and a 34-bed Medical-Behavioral Unit supporting patients with co-occurring medical and psychiatric conditions.
We specialize in treating brain and spinal cord injuries, chronic illnesses, neurobehavioral disorders, and adolescents with complex co-occurring diagnoses. At Nexus Health Systems, we are bridging medical and behavioral care so no patient falls through the cracks. Our programs deliver compassionate, specialty-driven treatment that helps individuals heal, grow, and achieve long-term success — because at Nexus, we’re mending minds.
The Social Worker Case Manager is a vital member of the interdisciplinary team, supporting patients and families from admission through discharge. This role focuses on safe, effective discharge planning, psychosocial assessment, patient/family advocacy, and strengthening communication between families and clinical teams. The Social Worker helps families navigate stressors, understand the care process, and access needed community resources — ensuring each patient transitions safely and smoothly back into their community.
Key Responsibilities Clinical & Assessment Complete social service screening, psychosocial assessment, and discharge planning assessment for each admission/readmission within 72 hours. Ensure assessments include all required policy elements and are documented clearly in the medical record. Develop a social services plan of care and integrate it into the interdisciplinary care plan.
Update care plans weekly during team conference. Family Support & Counseling Identify patients and families in need of counseling and provide support with warmth, empathy, and professionalism. Help patients and families focus on and resolve psychosocial issues affecting their hospital experience.
Act as a patient/family advocate during care plan discussions and conferences. Communication & Coordination Facilitate effective communication between families and the interdisciplinary treatment team. Coordinate family conferences with case managers and physicians during admission and discharge planning.
Work collaboratively with clinical staff to support required family education before discharge. Communicate team recommendations and level-of-care needs to families after each treatment conference. Discharge Planning Identify and document discharge barriers and collaborate with the team to resolve them early.
Maintain care provider relationships and locate appropriate community resources for post-discharge needs. Provide verbal and written referrals to patients and families. Initiate early communication with CPS when discharge barriers present significant safety or care concerns.
Documentation & Compliance Document progress, barriers, and interventions in the medical record thoroughly and timely. Maintain communication with staff members regarding updates in patient care. Perform other duties as assigned to support patient care and hospital operations.
Qualifications Education Bachelor’s degree in Social Work required Master’s degree in Social Work preferred Experience Minimum of 2 years of experience as a Social Worker or Case Manager Experience in a medical setting preferred Licensure/Certification Active Texas Social Work license required