Social Worker II - Case Management

• The Social Worker is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patient's resources and right to self-determination.
• The individual in this position has overall responsibility for to assess the patient for transition needs including identifying and assessing patients at risk for readmission.
• Conducts complex psycho-social assessment and intervention to promote timely throughput, safe discharge and prevent avoidable readmissions.
• This position integrates national standards for case management scope of services including:
• Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
• Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care
• Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
• Education provided to physicians, patients, families and caregivers •Leads a population of patients by service line and/or leads the team by being a resource to Tenet performance standards.

• Complex psycho-social transition planning assessment and reassessment and intervention,
• Assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies,
• Care coordination, d) implementation or oversight of implementation of the transition plan,
• Leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review,
• Making appropriate referrals to other departments, g ) communicating with patients and families about the plan of care,
• Collaborating with physicians, office staff and ancillary departments, I) assuring patient education is completed to support post-acute needs ,
• Timely complete and concise documentation in Case Management system, k ) maintenance of accurate patient demographic and insurance information,
• Precepts new staff members and acts as a resource to all staff,
• Facilitates TEMPO as needed,
• Participates in department quality improvement initiatives, and
• Other duties as assigned.

• Required: LCSW based on license requirements of the state in which the Tenet Hospital operates.
• Preferred: Accredited Case Manager (ACM).

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