Care Transition Manager Social Worker LMSW/LCSW PRN

Texas Health Resources•Fort Worth, TX

2d•Onsite

About The Position

The Care Transition Manager Social Worker (LMSW/LCSW) PRN position at Texas Health Ft. Worth is part of the Care Transition Management department. This role supports an 815-bed, Magnet-designated hospital that has served the community since 1930. Care Transition Management offers a rewarding career with family-friendly hours. The role involves supporting patients in transitioning to appropriate levels of care, reviewing readmission indicators, identifying primary care physicians, and completing transition evaluations within 24 hours of patient identification to begin discharge planning.

Requirements

Master's Degree Social Work Required
LMSW - Licensed Master Social Worker Upon Hire Required Or LCSW - Licensed Clinical Social Worker Upon Hire Required
CPR - Cardiopulmonary Resuscitation Upon Hire Required
Knowledge of Microsoft Outlook and Office (Word, Excel)
Customer service skills
Ability to engage in complex clinical decision-making and discharge planning
Strong oral and written communication skills
Strong commitment to interdisciplinary collaboration
Critical thinking, analysis and conflict resolution skills
Psychosocial and crisis intervention skills
Ability to prioritize and meet deadlines

Nice To Haves

3 Years’ experience in hospital/medical social work Preferred
1 Year discharge planning/care management Preferred
ACM - Accredited Case Manager Upon Hire Preferred
CCM - Certified Case Manager Upon Hire Preferred Or Other ANCC Upon Hire Preferred
Working knowledge of medical necessity criteria preferred

Responsibilities

Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner.
Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients and collaborates with the interdisciplinary team to identify high risk patients whose THRIL score may not have indicated appropriately.
Promotes discussion and assists in the identification of a primary care physician (PCP) for patients without a PCP.
Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning.
Identify community resources and service needs and facilitate appropriate referrals as needed.