Case Manager - MSW - PRN

Northeast Georgia Medical Center•Gainesville, GA

About The Position

The Case Management Social Worker provides medical social work services to patients receiving hospital care. The role assesses each referred patient’s social, psychological, cultural, environmental, and financial circumstances, along with disposition needs, and collaborates with the RN Case Manager, patients, families, healthcare team members, and community agencies to develop, implement, and evaluate plans addressing identified needs. The position uses crisis intervention, problem-solving, community organization, and advocacy skills to identify needs and resources in the hospital and community. The social worker may serve patients from neonates through geriatric adults and performs clinical duties according to population-specific guidelines and National Patient Safety Guidelines. The role provides cross-coverage for social workers across care-continuum settings as required, including weekend rotation, remote coverage, and on-call duties. The position also supports discharge planning, referrals and placement, community-resource access, patient and family support, and related documentation.

Requirements

Master’s degree in Social Work from an accredited School of Social Work.
One year of experience in a hospital, agency, or institution providing related healthcare services is preferred.
Strong clinical assessment, intervention, and counseling skills across child, adolescent, and adult age groups.
Excellent communication skills and a positive attitude.
Social work assessment and counseling skills.
Knowledge of state and federal programs that provide medical care and financial support, and knowledge of community resources.
Ability to work with diverse patient and staff populations and with individuals from varying cultural and socioeconomic backgrounds.
Ability to work independently and amicably in group situations.
Knowledge of professional conduct and practice.
Knowledge of long-term care regulations, financial eligibility, and admission criteria.
Knowledge of adoption and surrogacy policies and regulations.
Ability to develop new and effective solutions to problems and opportunities.
Ability to meet the individualized needs of patients.
Ability to work scheduled shifts, including weekend rotation, remote coverage, and on-call schedules.

Nice To Haves

Social work licensure is preferred.
One year of experience in a hospital, agency, or institution providing related healthcare services is preferred.
CCM (Case Management Certification) or ACM (American Case Management Certification) is preferred.

Responsibilities

Assess patients’ social, psychological, cultural, environmental, and financial situations and disposition needs, using a family systems theory framework.
Identify legal, financial, social, educational, and environmental factors that may affect medical care or discharge plans, and share critical information with the healthcare team.
Assess and ensure appropriate reporting of potential or actual abuse, neglect, or domestic violence.
Assess psychiatric or substance-use disorders upon request and initiate or help arrange appropriate interventions and referrals for treatment after discharge.
Use SBIRT techniques to identify risky alcohol and other drug use and help reduce related health consequences.
Coordinate discharge planning within the patient’s expected length of stay, including networking with the healthcare team and advocating for the patient’s Freedom of Choice and Medicare’s Important Message rights.
Attend multidisciplinary rounds and respond to calls, referrals, and consults within 24 hours.
Receive and coordinate referrals for appropriate post-acute placements, review electronic records, interview patients or families about facility preferences, obtain required signatures, complete DMA 6 when required, and ensure discharge documentation accompanies the patient.
Keep the team, patient, and family informed about post-acute plans; coordinate appropriate transportation; and update insurance, demographic, and level-of-care information as needed.
Assist patients with applications for indigent medications and connect patients and families with community resources, including resources for homelessness and discharge to a lower level of care.
Provide therapeutic support to patients and families, help them understand medical and discharge plans, and facilitate support groups as needed or requested.
Support case managers with difficult discharge placements and placements outside the USA for immigrants.
Maintain knowledge of community resources and communicate new resources to the team; participate in community, hospital, and system-wide committees or service projects as encouraged.
Communicate respectfully, respond to calls with appropriate resources or manage them satisfactorily, seek supervisory or other assistance when needed, and complete documentation of actions taken.
Perform clinical duties in accordance with the NASW Code of Ethics and work scheduled shifts, including weekend rotation, remote coverage, and on-call schedules.