Case Manager- Licensed MSW

Community Health Network•Indianapolis, IN

About The Position

The Case Manager assesses, plans, implements, coordinates, monitors, and evaluates services across the continuum of care to support quality patient outcomes and appropriate use of health care services. The role supports the healthcare team in facilitating smooth transitions between levels of care for patients and families. The Case Manager works with patients, families, physicians, nursing staff, the care management team, ancillary departments, post-hospital care providers, and community health resources to develop and implement safe, appropriate discharge plans. The position also provides advocacy, consultation, and coordination of needed services while maintaining timely and accurate documentation and supporting the care management team’s functions and development.

Requirements

LCSW or LSW license in the State of Indiana.
Master’s degree in Social Work.
At least 2 years of inpatient, outpatient, or home-based social work experience.
Ability to collaborate in a team setting.
Excellent communication skills.
Positive attitude toward problem-solving.

Nice To Haves

Experience with quality improvement methodology.

Responsibilities

Confer regularly with nursing staff and ancillary patient care departments about discharge plans, barriers, and delays.
Participate in developing and implementing a prioritized, goal-directed plan of care based on intermediate goals and outcome criteria.
Coordinate and facilitate care consistently and skillfully.
Document patient records accurately, clearly, concisely, and on time; record pertinent information for other team members.
Respect and protect the rights of patients and significant others.
Demonstrate sound judgment and knowledge in care and decision-making for designated patient populations, seeking guidance when appropriate.
Maintain accountability for professional practice and participate in staff development and continuing education.
Collaborate with nurse case managers on discharge planning and use of clinical pathways.
Maintain awareness of legal issues and participate in risk-reduction efforts.
Contribute to the development and evaluation of care management team functions, meetings, reports, and other team activities.
Use effective communication and problem-solving skills, including appropriate use of lines of authority.
Conduct discharge-planning assessments for identified patients and establish plans with patients, physicians, and the care management team.
Implement discharge plans, including referrals to home health agencies, return to ECFs, transportation, and other unmet needs for a safe transition to the next level of care.
Serve as a resource and consultant to unit staff, care team members, other staff, patients, families, and physicians.
Assess patient and family goals and biophysical, psychosocial, environmental, financial, and discharge-planning needs.
Procure services and advocate on behalf of patients and families.
Act as a liaison to post-hospital care providers and community health resources.
Apply knowledge of Medicare, Medicaid, and third-party payer guidelines.
Complete required paperwork for final disposition.
Interview patients and facilitate family and multidisciplinary conferences to formulate discharge plans.