Job Summary

The Case Management Social Worker is responsible for the provision of medical social work services to patients receiving care in the hospital setting. Assesses the social, psychological, cultural, environmental, and financial situation, as well as disposition needs for each referred patient. Collaborates with RN Case Manager, patients, families, healthcare team members, and community agencies to develop and implement plans to address identified needs. Evaluates effectiveness of plans and initiates change as needed. Uses crisis intervention, problem solving model, community organization, and advocacy skills in identifying needs and resources in the hospital and community. This position will come in contact with patients in the neonate, infant, child, adolescent, adult, and geriatric age groups; Employees will perform clinical duties in accordance with population specific guidelines and adhere to National Patient Safety Guidelines. Provides cross coverage for all Social Workers as required across all settings in the care continuum, including weekend rotation (as needed).

Minimum Job Qualifications

• Licensure or other certifications:

• Educational Requirements: Masters Degree in Social Work from an accredited School of Social Work; licensure preferred.

• Minimum Experience: One (1) year experience in a hospital preferred, agency or institution providing related health care services.

• Other:

Preferred Job Qualifications

• Preferred Licensure or other certifications: CCM (Case Management Certification) or ACM (American Case Management Certification) preferred.

• Preferred Educational Requirements:

• Preferred Experience:

• Other:

Job Specific and Unique Knowledge, Skills and Abilities

• Excellent communication skills, exhibits a positive attitude

• Social Work assessment and counseling skills

• Knowledge of state and federal programs that provide medical care and financial support to individuals, knowledge of community resources

• Ability to work with diverse patient and staff populations

• Ability to work independently and amicably in group situations

• Conversant with current thinking on professional conduct and practice

• Must have strong clinical assessment, intervention, and counseling skills across all age ranges; child, adolescent and adult

• Ability to work with individuals of varying cultural and socio-economic backgrounds

• Knowledge of Long Term Care regulations, financial eligibility and admission criteria

• Knowledge of adoption and surrogacy policies and regulations

• Demonstrates the ability to think 'outside of the box' and consistently create new, and effective solutions to today's problems and opportunities

• Demonstrates the minimum knowledge, skills, and abilities to care for the individualized needs of the patient

Essential Tasks and Responsibilities

• Uses a family systems theory framework to gather information, to include, patient's social, psychological, cultural, environmental and financial situation. Identified legal, financial, social, educational, and environmental factors which may affect medical care and/or discharge plans. Informs team members of critical information that will affect patient's stay while in the hospital and / or discharge plan. Assesses and assures appropriate reporting of any potential/actual abusive relationship, such as child/adult abuse, neglect or domestic violence. Assesses upon request an psychiatric/ substance abuse disorders and initiates or assists in arranging appropriate intervention and referrals for treatment upon discharge.

• Uses SBIRT techniques which allows for an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels with the goal of reducing and preventing related health consequences, disease, accidents and injuries.

• Expedites the discharge plan through excellent networking and team skills within the patient's expected length of stay per working DRG. Provides patient advocacy and ensures patient's Freedom of Choice and Medicare's Important Message. Attends multidisciplinary rounds to ensure timely communication with the team.

• Receives referrals for appropriate placement (NH, SNF, Assisted Living, LTAC, Acute Rehab etc., from Case Manager or Care Coordinator). Reviews patient information from the electronic record. Interviews patient and/or family for preference of facilities and secures signatures on Freedom of Choice form. Completes DMA 6 where required and obtains appropriate signatures. Updates any changes in insurance, demographic information, patient level of care, etc. Ensures appropriate discharge documentation is available to accompany patient to the facility. Stays in touch with the team, patient and family regarding post acute plans. Coordinates appropriate transportation.

• Assist with the application process for indigent medications working specifically with indigent programs and pharmacy assistance programs. Assists patients /families with the process to ensure community resources are obtained for discharge to lower level of care, to include homeless resources. Continuously seeks new community resources and keeps team informed.

• Provides therapeutic support for patients and families by listening to verbal communications and observing non-verbal behaviors. Assists patient and family in understanding medical plan of care and discharge plan. Facilitates support groups as needed.

• Provides support to the cases managers for difficult discharge placements and for immigrants that require placement outside the USA.

• Encouraged to participate on community-based committees. Encouraged to participated on hospital committees as related to post acute care services. Encouraged to participate on system-wide service projects. Facilitates support groups as requested.

• Responds to calls/referrals/consults within 24 hours. Communicates in a respectful manner. Responds to calls with appropriate resources or manages the call in a satisfactory manner. Contacts supervisor and other resources for assistance when needed. Completes all documentation related to actions taken.

• Performs clinical duties in accordance to NASW Code of Ethics.

• Works all scheduled shifts, including weekend rotation, remote coverage and on-call schedule.

Physical Demands

• Weight Lifted: Up to 50 lbs, Occasionally 0-30% of time

• Weight Carried: Up to 50 lbs, Occasionally 0-30% of time

• Vision: Moderate, Frequently 31-65% of time

• Kneeling/Stooping/Bending: Occasionally 0-30%

• Standing/Walking: Constantly 66-100%

• Pushing/Pulling: Occasionally 0-30%

• Intensity of Work: Constantly 66-100%

• Job Requires: Reading, Writing, Reasoning, Talking, Keyboarding