Care Transition Manager Social Worker Full time 40 hours

Texas Health Resources•Fort Worth, TX

3d•Onsite

About The Position

This role is for a full-time Care Transition Manager Social Worker at Texas Health Ft. Worth. The position is within the Care Transition Management department, supporting an 815-bed, Magnet-designated hospital. This is described as a rewarding career with family-friendly hours.

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

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.
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.