Social Worker II

Conifer Health Solutions•El Paso, TX

About The Position

The Social Worker facilitates care across the continuum through effective resource coordination, helping patients achieve optimal health, access care, and use resources appropriately while respecting their available resources and right to self-determination. The role assesses patients’ transition needs, including identifying and assessing those at risk for readmission, and conducts complex psychosocial assessments and interventions to support timely throughput, safe discharge, and prevention of avoidable readmissions. The position applies national case management standards by promoting appropriate length of stay, preventing readmissions, supporting patient satisfaction, and coordinating care to ensure that care is delivered in the right sequence and at the appropriate level. It also supports compliance with state and federal regulations, accreditation standards, and company policy; provides education to physicians, patients, families, and caregivers; and leads a patient population by service line and/or serves as a resource to the team on performance standards.

Requirements

  • Master of Social Work (MSW).
  • Currently licensed, certified, or registered to practice the profession as required by law, regulation, or policy in the state of practice; active license for the state(s) covered.

Nice To Haves

  • Two years of acute hospital experience.
  • Accredited Case Manager (ACM) certification.

Responsibilities

  • Conduct complex psychosocial transition-planning assessments and reassessments, and provide interventions.
  • Assist with adoption, abuse, and neglect cases, including assessment, intervention, and referrals to local, state, and/or federal agencies as appropriate.
  • Coordinate patient care.
  • Implement or oversee implementation of the transition plan.
  • Lead and/or facilitate multidisciplinary patient care conferences, including Complex Case Review.
  • Make appropriate referrals to other departments.
  • Communicate the plan of care to patients and families.
  • Collaborate with physicians, office staff, and ancillary departments.
  • Ensure patient education is completed to support post-acute needs.
  • Complete timely, concise documentation in the Case Management system.
  • Maintain accurate patient demographic and insurance information.
  • Precept new staff members and serve as a resource to staff.
  • Facilitate TEMPO as needed.
  • Participate in department quality-improvement initiatives.
  • Perform other duties as assigned.
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