Care Manager - Social Worker

GBMC HealthCare•Towson, MD

33d•$58,489 - $93,582

About The Position

The Social Worker in the Continuing Care Department is an integral member of a hospital patient’s care team, responsible for assessing and intervening to ensure the effective continuation of a patient’s care after discharge from the hospital. The social worker will be assigned to one or more units, which may include medical, surgical, intensive care, OB/Maternity, pediatric, and/or the Emergency Department, and will work closely with physicians, nurses, and other practitioners on the assigned unit. The Social Worker interviews hospital patients and family members or caregivers; facilitates family meetings to identify needs and develop continuing care plans; assesses psychosocial needs; and counsels patients and family members to promote effective coping and compliance with treatment plans. The role also includes assessing knowledge deficits and educating patients and family members about community resources, rights and responsibilities, advance directives, end-of-life care issues, health insurance, and navigating the health care system. The Social Worker coordinates complex care plans involving a wide range of internal and external services, including home health, social services, rehabilitation, and mental health providers, and advocates for patients to receive needed resources and services. The role functions as part of a multidisciplinary team. As opportunities arise, the Social Worker participates in department and hospital initiatives related to process improvement and patient care.

Requirements

Master’s degree in Social Work; equivalent experience or certification will be considered.
Licensed in Maryland as an LMSW or LCSW.
1–3 years of prior social work experience in a hospital, nursing care facility, or other health care setting; discharge planning experience is preferred.
Cultural competency and willingness to work with patients of varied racial, national, ethnic, and religious backgrounds, age groups, and socioeconomic statuses.
Basic computer skills; electronic medical record training is provided.
Interview skills including active listening, open-ended questioning, and empathy.
Assessment skills to quickly develop thorough assessments and care plans.
Skill in, or willingness to learn, counseling and motivational interviewing techniques.
Willingness to engage with difficult or noncompliant patients or family members and discuss topics such as end-of-life care or substance abuse.
Ability to self-direct and negotiate competing priorities.
Ability to develop a wide-ranging working knowledge of services, referral processes and criteria, medical terms, and medical needs; training is provided.
Ability to work in a fast-paced environment and desire to engage with change processes and work closely with multidisciplinary teams.

Nice To Haves

Prior discharge planning experience.

Responsibilities

Interview hospital patients and their family members or caregivers.
Facilitate family meetings to identify needs and develop continuing care plans.
Assess patients’ psychosocial needs and knowledge deficits.
Counsel patients and family members to promote effective coping and compliance with treatment plans.
Educate patients and family members about community resources, rights and responsibilities, advance directives, end-of-life care issues, health insurance, and navigating the health care system.
Coordinate complex care plans involving internal and external services, including home health, social services, rehabilitation, and mental health providers.
Advocate for patients to receive needed resources and services.
Work as part of a multidisciplinary team with physicians, nurses, and other practitioners.
Participate, as opportunities arise, in department and hospital initiatives related to process improvement and patient care.
Apply knowledge of patient and workforce safety in relation to job duties.
Demonstrate competency in care delivery and apply knowledge to meet age-specific needs, if applicable.