Care Transition Manager Social Worker LMSW/LCSW Part-time Weekends

Texas Health•Fort Worth, TX

12d•Onsite

About The Position

The Care Transition Manager Social Worker is responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner. This role involves reviewing readmission indicator scores, collaborating with the interdisciplinary team to identify high-risk patients, and promoting discussion for primary care physician identification. The position requires completing transition evaluations and initiating discharge planning within 24 hours of patient identification. This is a part-time weekend position within the Care Transition Management department at Texas Health Ft. Worth.

Requirements

Master's Degree Social Work Required
LMSW - Licensed Master Social Worker Upon Hire Required
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
1 Year discharge planning/care management
ACM - Accredited Case Manager Upon Hire Preferred
CCM - Certified Case Manager Upon Hire Preferred
Other ANCC Upon Hire Preferred
Working knowledge of medical necessity criteria

Responsibilities

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.
Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner.