Social Worker - Case Management

Conifer Health Solutions•Modesto, CA

About The Position

The Social Worker facilitates care along a continuum through effective resource coordination to help patients achieve optimal health, access to care, and appropriate utilization of resources, while balancing patient resources and the right to self-determination. The role ensures care is provided at the appropriate level based on medical necessity and assesses transition needs to promote timely throughput, safe discharge, and prevention of avoidable readmissions. It includes complex psychosocial assessment and intervention. The position integrates national case management standards for transition management, care coordination, regulatory and accreditation compliance, education, and social work planning. The Social Worker works with physicians, patients, families, caregivers, staff, community providers, and other departments to coordinate care and support safe transitions. Responsibilities also include documentation, staff support, and participation in quality improvement activities.

Requirements

Master in Social Work (MSW).
Demonstrated organizational skills.
Excellent verbal and written communication skills.
Ability to lead and coordinate activities of a diverse group of people in a fast-paced environment.
Critical-thinking and problem-solving skills.
Computer literacy.

Nice To Haves

Minimum of two years of acute hospital experience preferred.

Responsibilities

Facilitate care coordination and promote appropriate utilization of resources and levels of care.
Assess and reassess transition needs, including conducting complex psychosocial assessments and interventions.
Implement or oversee implementation of transition and discharge plans to promote timely throughput, safe discharge, and readmission prevention.
Assist with adoption, abuse, and neglect cases through assessment, intervention, and referrals to appropriate local, state, or federal agencies.
Lead 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, ancillary departments, and community providers.
Ensure patient education is completed to support post-acute needs and develop educational resources for staff and patients or their representatives.
Provide in-service education for staff and precept new staff members; act as a resource to staff.
Plan the social work component for selected hospital programs.
Ensure timely, complete, and concise documentation in the Case Management system and maintain accurate patient demographic and insurance information.
Facilitate TEMPO as needed.
Participate in department quality improvement initiatives.
Comply with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy.
Perform other duties as assigned.