Care Transition Manager, Social Worker - Full time, Days

Texas Health Resources•Frisco, TX

4d•Onsite

About The Position

This full-time, day shift position is for a Care Transition Manager Social Worker within the Care Management department at Texas Health Frisco. The role involves ensuring patients are transitioned to appropriate levels of care in a timely and effective manner. The department is highlighted by an engaged leadership team, manageable caseloads, and a team that works together to ensure work/life balance.

Requirements

Master’s degree in social work required
One year of experience of discharge planning/care management
LMSW – Licensed Master Social Worker upon hire required or LCSW – Licensed Clinical Social Worker upon hire required
CPR -Cardiopulmonary Resuscitation upon hire required

Nice To Haves

Three years of experience in hospital/medical social work preferred
Hospital Case management preferred
ACM – Accredited Case Manager upon hire preferred or CCM – Certified Case Manager upon hire preferred or Other – ANCC upon hire preferred

Responsibilities

Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients
Identify high risk patients whose THRIL score
Promotes discussion and assists in the identification of a primary care physician (PCP) for patients
Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning
Interviews and assesses patients and caregivers as part of the transition evaluation
Identifies transition needs and discusses funding of post-transition care with patients and caregivers