MSW LMSW SW Care Coordinator - Complex Case Assignment

University of Texas Southwestern Medical Center • Dallas, TX

34d • Onsite

About The Position

This role will be an LMSW Care Coordinator with a special assignment as a Complex Case Manager. They will work with patients and families at Clements University Hospital and Zale Lipshy Pavilion. They will have a special focus on high risk and complex (psychosocial and medical) patients as well as those with an extended length of stay for discharge planning needs. They will carry an assignment as the primary care coordinator and act as a resource to consult on patient's being managed by other staff. The Social Worker Care Coordinator is a member of the Care Coordination Department (a Hospital department) who educates the healthcare team and physicians about psychosocial issues and any identified patient/family problems as well as strategies to address the issues. Applies specialized knowledge and advanced practice skills in assessment, treatment, planning, implementation and evaluation, case management, mediation, counseling, supportive counseling, direct practice, information and referral, supervision, consultation, education, research, advocacy, community organization and developing, implementing and administering policies, programs and activities. This position will not apply specialized clinical knowledge and advanced clinical skills in assessment, diagnosis, and treatment of mental, emotional, and behavioral disorders, conditions and addictions, including severe mental illness and serious emotional disturbances in adults, adolescents, and children. This position integrates national standards for case management scope of services including: Care Coordination- A process whereby screening/identification, assessment, planning, sequencing of care and communication, when effectively integrated, ensure and advance the plan of care to support successful transitions. Compliance- Knowledge related to federal, state, local hospital and accreditation requirements that impact scope of services to include, Centers of Medicare and Medicaid Services (CMS) Condition of Participation. Transition Management- Planning that begins at the time of the initial patient encounter (preadmission, admission, emergency department, etc.) and is reevaluated and adjusted throughout the patient's hospital stay. Care Coordinators (both SW and RN) will arrange/ensure all elements of the transition plan are implemented and communicated to key stakeholders including, but not limited to, the health care team, patient/family/ caregiver, and post-acute providers. Care Coordinators will convey all necessary information for continuity of care and patient safety, verify receipt and provide a venue for additional questions and/or information requests/needs

Requirements

• Excellent written and verbal communication
• Superior knowledge of community resources
• Ability to educate patient on Medicaid, Medicare, and different insurance plans
• Ability to educate patient/family on limitations of their individual insurance plan and services available
• Verbal de-escalation techniques and abilities
• Superior interdepartmental coordination
• Excellent knowledge of medical social work tasks and workflows in an inpatient hospital setting
• (LMSW) LIC MASTER SOCIAL WORKER licensed in the state of Texas.

Nice To Haves

• 2 years hospital experience

Responsibilities

• Screens and evaluates high risk patients for discharge planning needs. Consults with attending physicians and members of the healthcare team regarding any identified psychosocial issues and/or care transition barriers.
• Recognizes that the transiton process is collaborative with the multidisciplinary team to include the patient/family and assists with executing the plans and interventions to facilitate the hospital stay and manage length of stay and reassesses as care needs change.
• Facilitates patient care conferences as indicated, to include complex cases to proactively assist with establishing a safe and effective discharge plan.
• Implements the transition of care plan to the next level through appropriate service referrls and assures that the patient is given choice in regards to agencies and services.
• Assists with adoptions, abuse and neglect cases, including assessment and investigation, intervention and referral as appropriate to local, state, and/or federal agencies, as indicated.
• Educates and provides information and resources to patients and families regarding the availability of community resources. Interprets patient and family needs and provides information concerning availability and limitation of resources.
• Maintains open communications with community agencies to appropriately assist in referring and meeting patient needs.
• Maintains knowledge of payor benefits, hospital and community resources, and regulatory standards to ensure informed decision making, continuity of care, and desired outcomes (i.e. medical, medical cost, quality of life, and patient satisfaction).
• Maintains chronological notes, clinical charts, statistical data, or case histories for each patient with respect to social problems, adjustments for patient and family involvement, and actions taken or planned.
• Duties performed may include one or more of the following core functions: (a) Directly interacting with or caring for patients; (b) Directly interacting with or caring for human-subjects research participants; (c) Regularly maintaining, modifying, releasing or similarly affecting patient records (including patient financial records); or (d) Regularly maintaining, modifying, releasing or similarly affecting human-subjects research records.
• Performs other duties as assigned.

Benefits

• PPO medical plan, available day one at no cost for full-time employee-only coverage
• 100% coverage for preventive healthcare-no copay
• Paid Time Off, available day one
• Retirement Programs through the Teacher Retirement System of Texas (TRS)
• Paid Parental Leave Benefit
• Wellness programs
• Tuition Reimbursement
• Public Service Loan Forgiveness (PSLF) Qualified Employer

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Educational Services
• Number of Employees: 5,001-10,000 employees