About The Position

The Social Worker Care Manager is responsible for providing appropriate interventions and discharge planning services to patients and families. They facilitate a smooth transition for the patient throughout the continuum of care by accessing hospital, community, and governmental resources. They also provide clinical supervision to peers, Social Workers, and students.

Requirements

  • Bachelor of Social Work (required)
  • BLS Basic Life Support – American Heart Association (required)
  • Licensed as a Social Worker in state of practice (required, preferred in VA)
  • 1 year of experience in clinical setting (required)

Nice To Haves

  • Master’s degree in social work or healthcare related field (preferred)
  • Accredited Case Manager Certification (ACM) from American Case Management Association or Certified Case Manager (CCM) from Commission for Case Manager Certification (preferred)
  • 3 year of experience in an acute care clinical setting (preferred)
  • Ambulatory or post-acute, care coordination experience (preferred)

Responsibilities

  • Identifies and prioritizes patients in need of social services, using a holistic approach inclusive of biopsychosocial, functional, cultural, spiritual, and financial factors.
  • Plans with the patient, caregivers and members of the healthcare team to maximize health care responses, quality and cost-effective outcomes.
  • Monitors and revises the plan as indicated when patient condition changes.
  • Completes all necessary documentation. Maintains, clear, concise, and timely documentation in the patient record to reflect the needs of the patients.
  • Documentation will reflect plan of care to address post hospital care needs and resources and evidence of patient, family, or caregiver involvement in planning.
  • Ensuring patient’s and caregiver’s treatment goals and preferences are incorporated into the transition of care planning and communicated to the multidisciplinary team.
  • Follow standardized practices and process related to Advance Care Planning, Length of Stay management and readmission prevention.
  • Supports denial prevention related to medical necessity through addressing / removing barriers to progression of care and participating in Interdisciplinary Discharge Rounds.
  • Supports and promotes assertive, proactive care for patients, assisting in removing barriers related to achieving timely testing and treatment.
  • Ensures resources are utilized appropriately and offering alternatives to acute care to the care team.

Benefits

  • Competitive pay, incentives, referral bonuses and 403(b) with employer contributions (when eligible)
  • Medical, dental, vision, prescription coverage, HSA/FSA options, life insurance, mental health resources and discounts
  • Paid time off, parental and FMLA leave, short- and long-term disability, backup care for children and elders
  • Tuition assistance, professional development and continuing education support
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