Social Worker, Case Management - Full Time

OVERVIEW Job Profile Summary The Case Management Social Worker 1 coordinates and facilitates patient care activities to improve continuity of care across the health care continuum, to promote appropriate utilization of resources, and to contribute to improved patient satisfaction and outcomes. The CMSW 1 provides services and support to patients and families who are referred to Social Services or by case finding. The CMSW 1 provides discharge planning as needed. The CMSW 1 is a strong patient advocate. Working in collaboration with the Patient Navigator and the Multidisciplinary team, the CMSW 1 assesses and intervenes with high risk patients that require a high level of continuing care services while ensuring compliance with regulatory standards of care at the organizational, state and federal level. As needed, the Social Worker conducts clinical review for utilization management; corresponding with payers and utilizing established criteria sets. **ESSENTIAL DUTIES AND RESPONSIBILITIES** - Provides psychosocial assessment, intervention and facilitates referrals to community resources to hospital patients in a variety of care settings. - Formulates, develops and implements psychosocial treatment plan utilizing appropriate social work interventions which may include crisis intervention and grief and bereavement services. - Assesses referred patients, within prescribed time frames, for transitional planning needs, including any barriers to discharge, family and social supports, capacity for self-care, adaptive abilities and financial resources. - Develops individualized, patient-focused plan for meeting continuing care needs. - Provides education and resource options available to patients and families. Facilitates and assists with legal issues within scope of practice (POAHC, Guardianship, Patient Rights, and Adoption). - Reviews advance directives and helps patients to complete new documents. - Communicates effectively with physicians, patients, families and multidisciplinary team to ensure that the patient's right to self-determination is met. - Provides education and support to patients, families in regard to issues related to adaptation to the patient's diagnosis, illness, treatment and or life situation. - Maintains detailed knowledge of community resources to effectively address patient needs and help to strengthen patient's network of support. - Documents plan of care, interventions, and progress toward goals in the medical record in a timely and concise manner. - Facilitates crisis intervention services in the hospital setting as determined by scope of practice. - Identifies and reports child and or elder abuse to local authorities according to law. - Acts as a liaison with county officials for patients involved with protective services, aging, developmental disabilities, domestic violence, mental health services and economic support. - Maintains current knowledge and awareness of payer, reimbursement practice and regulations impacting the patient's plan of care. - Negotiates care issues as appropriate (indigent issues and availability of resources). - Promotes customer satisfaction and intervenes at critical moments of service. - Monitors inpatient readmissions for potential failed discharge plans or need for specialized intervention. - Provides follow-up with patients as needed. - Assists with identifying avoidable day information for organizational tracking and trending. **EDUCATION AND/OR EXPERIENCE** Bachelor's degree from accredited college or university (BSW or equivalent) required. One to two years related experience and or training in acute care setting is desirable. **CERTIFICATION/LICENSURE** LSW or CSW in state of practice required. Case Management Certification (ACMA) preferred. **OTHER SKILLS AND ABILITIES** **Phone Skills** Must be skilled with use of voice mail and phone features. Must be able to use available technology for language interpretation. **Computer Skills** Must have expert knowledge of Allsc…