Acute Care, Case Management, Clinical Medicine, Communication Skills, Computer Skills, Cost Control, Cross-Functional, Discharge Plans, Educational Evaluation, Health Plan, Healthcare, Interpersonal Skills, Medicine, Negotiation Skills, Patient Assessment, Patient Education, Registered Nurse (RN), Resource Utilization, Service Delivery, Social Work
LOCATION
Memphis, TN
POSTED
30+ days ago
Overview
Job Summary
Manages the care for a specific group of patients; facilitates the safe movement of patients throughout the continuum of care, ensures optimal utilization of resources, service delivery and compliance with external review agencies, local, state, and federal requirements. Collaborates with patients/families and the healthcare team in the transition planning process. Provides psychosocial assessments, education to patients/families to assist in coping with the patient's hospitalization and post acute care needs. Performs other duties as assigned.
Responsibilities
Perform a comprehensive psychosocial assessment when triggered to identify the patient's health goals and coordinate services with the RN Case Manager for an effective transition plan. Meets directly with patient/family on an ongoing basis as identified.
Identify the need for patient/family regarding Social / Psychosocial issues that need to be addressed.
Build on the discharge planning assessment in developing, coordinating, implementing and revising a care plan to ensure good transition management and continuity of care (LOS, discharge delays), cost reduction and patient self-management (patient activation).
Collaborates with the physician and all members of the multidisciplinary team to facilitate care and assist in meeting discharge goals.
Completes assigned goals.
Specifications
Experience
Minimum Required
Preferred/Desired
Education
Minimum Required
Bachelors in Social Work
Preferred/Desired
Training
Minimum Required
BSW graduate of an accredited school of social work
Preferred/Desired
2 years clinical experience as a social worker in medical/clinical setting
Special Skills
Minimum Required
Excellent interpersonal communication and negotiation skills. Ability to identify and coordinate appropriate resources in the community. Ability to work with people of all social, economic, and cultural backgrounds. Computer skills.