About The Position

The Social Worker Care Manager provides appropriate interventions and discharge planning services to patients and families, facilitating smooth transitions throughout the continuum of care by accessing hospital, community, and governmental resources. The role also provides clinical supervision to peers, Social Workers, and students. The position identifies and prioritizes patients who need social services through a holistic approach that considers biopsychosocial, functional, cultural, spiritual, and financial factors. The Care Manager plans with patients, caregivers, and the healthcare team to support quality, effective, and cost-conscious outcomes, and monitors and revises plans as patient conditions change. The role maintains timely and complete documentation of patient needs, care plans, post-hospital resources, and patient or caregiver participation, while ensuring their goals and preferences are incorporated into transition planning and shared with the multidisciplinary team. The Care Manager follows standardized practices for Advance Care Planning, length-of-stay management, and readmission prevention. The role supports medical-necessity denial prevention by addressing barriers to progression of care and participating in interdisciplinary discharge rounds. It also promotes proactive care, helps remove barriers to timely testing and treatment, ensures appropriate resource use, and offers alternatives to acute care to the care team.

Requirements

  • Bachelor of Social Work.
  • BLS Basic Life Support certification from the American Heart Association.
  • Licensure as a Social Worker in the state of practice.
  • At least 1 year of experience in a clinical setting.
  • Skills in Social Work, Care Management, ethics, end-of-life ethics, patient advocacy, clinical supervision, and Microsoft Office.
  • Ability to prioritize many simultaneous demands and tolerate frequent interruptions.
  • Interpersonal skills including attention to detail, critical thinking, communication with family members, conflict resolution, active listening, relationship building, problem solving, teamwork, collaboration, empathy, negotiation, time management, prioritization, and openness to change.

Nice To Haves

  • Master’s degree in social work or a healthcare-related field.
  • Accredited Case Manager (ACM) certification from the American Case Management Association or Certified Case Manager (CCM) certification from the Commission for Case Manager Certification.
  • At least 3 years of experience in an acute-care clinical setting.
  • Ambulatory or post-acute care coordination experience.

Responsibilities

  • Identify and prioritize patients in need of social services using a holistic assessment of biopsychosocial, functional, cultural, spiritual, and financial factors.
  • Plan with patients, caregivers, and healthcare team members to maximize care responses and achieve quality, cost-effective outcomes.
  • Monitor and revise care plans when a patient's condition changes.
  • Complete and maintain clear, concise, and timely documentation in patient records.
  • Document post-hospital care needs, resources, and patient, family, or caregiver involvement in planning.
  • Incorporate patient and caregiver treatment goals and preferences into transition-of-care planning and communicate them to the multidisciplinary team.
  • Follow standardized practices and processes for Advance Care Planning, length-of-stay management, and readmission prevention.
  • Support medical-necessity denial prevention by addressing or removing barriers to progression of care and participating in Interdisciplinary Discharge Rounds.
  • Promote proactive care and help remove barriers to timely testing and treatment.
  • Ensure appropriate resource utilization and offer alternatives to acute care to the care team.
  • Provide clinical supervision to peers, Social Workers, and students.

Benefits

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