Gainesville, Georgia
Durham, North Carolina
Fredericksburg, Virginia
Posted: 05-Feb-25
Location: Winter Park, Florida
Categories:
Internal Number: 25002820
All the benefits and perks you need for you and your family:
- Benefits from Day One
- Paid Days Off from Day One
- Career Development
- Whole Person Wellbeing Resources
Our promise to you: Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.
Schedule: Full-Time; 5 days -8 hours shift, will be assigned weekend shifts on rotation with the rest of the team.
Shift: Days
Location: 201 NORTH LAKEMONT AVENUE, Winter Park, 32792
The community you’ll be caring for:
The role you’ll contribute: The Social Work Care Manager intervenes with patients who have complex psychosocial needs, require assistance with eligibility determination for social programs, funding sources and qualify for community assistance from a variety of special assistance programs and agencies, and/or require assistance with transitions of care or discharge planning. In addition, offer crisis intervention to patients and families with psychosocial needs and coordinates and facilitates the development of a discharge plan of care for high-risk patient populations. This role will receive referrals for individuals from at-risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care Manager, in collaboration with the patient/family, care manager nurses, nurses, physicians and the interdisciplinary team, ensures patient-centered care coordination through the continuum of care. The Social Work Care Manager ensures efficient and cost-effective care through appropriate resources monitoring and clinical care escalations. The Social Worker is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient evaluations of post-hospital needs; development of a transition of care plans and initiation of the implementation of the transitions of care plans prior to the discharge of the patient. The Social Work Care Manager is responsible for optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management. The Social Work Care Manager communicates daily with the interdisciplinary team during daily multidisciplinary rounds. Care coordination, discharge planning, transitions of care planning and are core competencies of this role. The Social Work Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to timely and efficient care delivery and reimbursement. The Social Work Care Manager provides education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination. The Social Work Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations. The Social Work Care Manager adheres to departmental and system goals, objectives, policies and procedures and ensures quality patient care and regulatory compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.
The value you’ll bring to the team:
· Psychosocial Assessment and Interventions oAssesses patient's and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, assisting those coping with adjusting to significant life transitions oIntervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs oServes as a resource to provide information and intervention related to treatment decisions, terminal illnesses and end[1]of-life issues oProvides grief counseling and crisis intervention skills oAdvocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the healthcare system oProvides de-escalation services for patient/family as appropriate oProvide Motivational Interview techniques for patients with substance use and addictive disorders oProvides patient/family education, adjustment-to-illness counseling, grief counseling and crisis intervention oProvides education to patients/families/caregivers regarding resource options and coping with diagnosis, treatment and prognosis oWorks in collaboration with hospital and community agencies to obtain needed services and resources for patients/families/caregivers
· Receives referrals for psychosocial complex needs from the health care team.
· Provides assessment and reporting interventions in child abuse/neglect, domestic violence, adult/elderly abuse, child protection, sexual assault, and human trafficking as appropriate.
· Provides consult services for patients who may possibly lack decision making capacity. Follows the guardianship (temporary/ permanent) policies and procedures and coordinates with Care Management leadership throughout the process.
· Provides consult services for foster care and adoptions.
The expertise and experiences you’ll need to succeed:
Minimum qualifications:
· Masters in Social Work (MSW)
· Minimum three (3) years experience in hospital/medical social work
Preferred qualifications:
· Care Management discharge planning experience
· Knowledge of state and federal guidelines pertinent to care management
· Licensed Clinical Social Worker (LCSW)
ACM/CCM certification
This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.