Discharge planning for hospital inpatients 1) Collaborate with other hospital disciplines, medical staff, and outpatient providers to develop plans for aftercare. 2) Assess patients for discharge planning needs and identify resources 3) Organize and attend patient care conferences to further identify each patient’s potential discharge needs 4) Act as community liaison with outpatient providers and collateral and connects patients to resources to ensure timely discharges 5) Establish and maintain positive working relationships with all referral sources 6)Coordinate and comply with legal requirements to ensure all patients are in appropriate legal standing 7)Complete utilization review for all patients in caseload 8) Complete initial evaluation to identify patient needs and place in medical record according to department policy 9) Develop and update discharge plan according to patient needs; document plan in the medical record according to departmental policy. Provision of clinical services to patients and families 1) Provide information regarding community resources for ongoing counseling services 2)Lead group therapy sessions as needed and determined by the department schedule. 3) Utilize crisis intervention techniques when indicated 4) Evaluate patient/family psychosocial factors to inform clinical interventions and identify patient needs 5) Provide appropriate clinical interventions to facilitate recovery Timely and complete documentation to meet department policy, licensure and 3rd party payor requirements 1) Documentation reflects accurate psychosocial assessment, case progress, collateral contact, and discharge plan. Functions as a member of the unit based care management team 1) Keeps staff informed of Social Work progress and notifies appropriate personnel on case progress 2) Collaborates with members of the health care team as indicated 3) Evaluates the patient/family’s psychosocial needs in relation to the patient's medical needs 4) Attends patient care conferences and multi-disciplinary team conferences. Attendance at educational seminars as appropriate and as required to maintain licensure 1) Continuing education is a professional responsibility 2) Continuing education units (CEU’s) required for licensure will be completed and documented within the state of Illinois timeframes. Contributes to Continuous Process Improvement activities 1) Participated in a CPI team as indicated. 2) Collects data as requested by department head.
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Job Type
Full-time
Career Level
Mid Level