Social Work Care Manager PRN
About The Position
This role receives referrals from interdisciplinary team members and provides crisis interventions and addresses psychosocial needs for patients and families. Responsible for evaluating patients for discharge planning needs and in collaboration with physicians, nurses, and the interdisciplinary team, provides patient care coordination, monitors medical necessity, provides care progression, provides patient and family advocacy, completes post-acute care planning, and implements discharge plans for patients in the acute care setting. This includes assisting patients with social programs and community assistance to address social drivers of health. This role ensures compliance with CMS CoPs for Discharge Planning, federal, and state regulatory requirements. This role is responsible to progress care to achieve length of stay goals, while reducing avoidable readmissions and improving consumer experience. Receives referrals from the interdisciplinary team and provides patient family advocacy, discharge planning coordination, and intervention for identified high risk patients and or other patient case referrals, as necessary.
Requirements
- Master's [Required]
- 2 social work [Required]
Nice To Haves
- 2 care management experience [Preferred]
- Accredited Case Manager (ACM) [Preferred]
- Certified Case Manager (CCM) [Preferred]
Responsibilities
- Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.
- Assesses patients and families wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.
- Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.
- Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.
- Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
Benefits
- Employees who switch from PRN to Full or Part Time employment get access to Day One Benefits (Immediate)
- PRN (per diem) team members may contribute to the Adventist HealthCare Retirement Plan (but are ineligible for employer contributions to the plan)
- Whole Person Well-being and Mental Health Resources
- Employee Discount Program, including tickets, travel, Pet Insurance, and More!
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What This Job Offers
Industry
Ambulatory Health Care Services
Number of Employees
5,001-10,000 employees
