Social Work Care Manager - (Job Number: 23001826) Pay: Competitive
Employment type: Part-Time
Job Description Position Summary: Provides assessment and intervention to assist clients/families in improving social and economic difficulties that interfere with health and wellness through casework principles, strategies, and community resources. Provides discharge planning services, assessments, and coordination of post-hospital care, linking patients and families to appropriate emotional, medical, and spiritual care options. Receives referrals from interdisciplinary team members for at-risk populations.
Essential Functions and Responsibilities: Performs high-level triage of all patients, focusing on those with complex psychosocial or financial issues, placement needs, and community service needs within 24 hours of admission.
Receives RN Care Manager referrals based on identified Social Work Triggers (see SW Referral SOP).
Identifies and assesses barriers early in the patient’s stay, developing a plan with the patient, family, healthcare team, payers, and community resources (e.g., LOS barriers to discharge).
Assesses patient and family needs for support and community services, educates and refers them to resources, arranges appointments, and establishes rapport with agencies.
Assesses risk of readmission for specific patient populations and initiates interventions to facilitate successful transition along the care continuum.
Participates in family care conferences and interdisciplinary meetings, providing consultation for patients, families, and staff.
Reports avoidable days, variances, or service delays to leadership.
Identifies patient and family preferences, needs, and strengths to support the interdisciplinary team.
Interviews patients and significant others to assess psychosocial situations and identifies the primary contact family member.
Develops discharge plans in collaboration with the patient, family, physicians, and healthcare team.
Manages complex cases and advocates for patients and families during care planning and discharge processes.
Utilizes knowledge of insurance benefits to optimize resource utilization.
Documents assessments, plans, interventions, barriers, and re-assessments in the EMR, ensuring proper transfer of information to post-acute agencies.
Collaborates with healthcare team members to ensure safe, appropriate, and timely care transitions.
Partners with external agencies to ensure continuity of care and empower patient independence.
Represents the care management department on teams and projects.
Performs other duties as assigned.
Qualifications: Required:
Licensed Master’s Social Worker (LMSW), with certification obtained within one year of eligibility and ongoing education compliance.
State licensure as a Licensed Bachelor Social Worker (LBSW), with certification obtained within one year of eligibility and ongoing education compliance.
American Case Management Certification (ACM) or eligible for certification, with ongoing education compliance.
Preferred:
Certification in Case Management (ACM or CCM)
Three years of acute hospital care or social work experience
Basic Life Support (BLS) certification from AHA, Red Cross, or equivalent.
About the company The McLaren Health Care system includes 15 hospitals, 2 HMOs, ambulatory surgery centers, diagnostics, and an employed physician network.
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