Social Worker Thompson Peak

HonorHealth•Scottsdale, AZ

5d•Onsite

About The Position

The Social Worker is accountable for an assigned caseload and works collaboratively with patients, caregivers, healthcare providers, and external partners to coordinate care and communicate complex information across the healthcare continuum. The role supports smooth transitions of care, positive patient and family experiences, quality outcomes, and cost-effective care. The Social Worker collaborates with patients and caregivers early in an inpatient or outpatient episode to prepare for discharge. This includes addressing supportive care, end-of-life decisions, community resources and programs, goal setting, and long-term planning. The position identifies and carries out safe post-acute interventions, assesses readmission risks and outpatient barriers to care, and assists patients with advance directives. The role facilitates timely transitions to the appropriate level of care by coordinating communication and care plans among hospitalists, specialists, primary care providers, and other partners. It communicates financial obligations and other discharge information to patients and their representatives, coordinates handoffs to the next case management team, and shares relevant inpatient and discharge information with payers to obtain service authorizations. The Social Worker promotes collaboration among healthcare team members, patients, families, and significant others; contributes to case management metrics; and manages an assigned caseload. The role may advocate for patients throughout the continuum, support communication among physicians, patients, and families, and monitor care using applicable standards and evidence-based practice guidelines. It applies knowledge of relevant laws, regulations, government and insurance benefits, and professional practice standards. Other related duties may be assigned.

Requirements

Master's Degree in Social Work.
At least 1 year as a Licensed Social Worker, or successful completion of a health-related field placement in a Master's-level Social Work program.
Current licensure as one of the following: LSW (Licensed Social Worker), LMSW (Licensed Master Social Worker), or LCSW (Licensed Clinical Social Worker).

Nice To Haves

Experience in the WIS Service Line.
At least 2 years in case management.
At least 3 years as a Licensed Social Worker.
Experience managing behavioral health patients.
Case Management Certification.

Responsibilities

Manage an assigned caseload.
Collaborate with patients and caregivers early in inpatient or outpatient care to prepare for discharge, including supportive care, end-of-life decisions, community resources, goal setting, and long-term planning.
Interview patients and identify and carry out safe post-acute interventions, including home visits, behavioral health service coordination, guardianship, repatriation, adoptions, CPS, APS, and ALTAC.
Assess readmission risk and outpatient barriers to care, including home support, medication management, and expectations.
Initiate and assist patients with advance directives.
Coordinate communication of clinical information and the plan of care among hospitalists, specialists, primary care providers, and other key providers to support timely transitions to the appropriate level of care.
Communicate financial obligations and other discharge-plan information to patients, families, and medical power of attorney representatives.
Ensure effective transition and final handoff to the next appropriate level-of-acuity case management team.
Communicate information about inpatient stays and discharge plans to payers to obtain service authorization.
Promote integrated, targeted, appropriate, and beneficial care through collaboration among healthcare team members, patients, families, and significant others.
Participate in developing and maintaining Case Management metrics.
Advocate for patients as needed, facilitate communication, and monitor care using standards of care and evidence-based practice guidelines.
Apply knowledge of applicable laws, regulations, government and insurance benefits, and practice guidelines and standards.
Perform other related duties as assigned or requested.