Social Worker MSW, Case Management, Full-time, Days
Job description
Employment Type:
Full timeShift:
Day ShiftDescription:
To provide professional discharge planning services through assessments, and coordination ofpost-hospital care needs to patients and their families. Provides resources and choices to families
to effectively link them to the needed level of emotional, medical and spiritual care.
This role will receive referrals for individuals from at-risk populations from interdisciplinary
team members (including physicians, Care Managers, staff nurses and other members of the
care team). Participates as an active member of multi-disciplinary team.
Complex Discharge Planning based on assessment of patient and family
needs, preferences and available resources in order to ensure a timely
discharge and to provide appropriate linkage with post-discharge care
providers( i.e. New/Resumptions SNF, LTAC, Rehab, Dialysis, Hospice,
DME and Home Health etc.)
1.Develops discharge plan in direct consultation with patient, family, physician, and
health care team. Deals with families exhibiting complex family dynamics that
impact directly on patient care and discharge.
2.Manages complex cases/situations and intervenes with and advocates for patients
and families as plan of care and discharge plan are developed.
3.Educates patients and families regarding appropriate resources, access to services
and third party requirements, and makes appropriate and timely referrals to
address post-acute discharge needs.
4.Provides consultation to Case Managers when coordination with significant or
intensive community resources is necessary to achieve desired treatment outcomes
Our Commitment to Diversity and Inclusion
Trinity Health is a family of 115,000 colleagues and nearly 26,000 physicians and clinicians across 25 states. Because we serve diverse populations, our colleagues are trained to recognize the cultural beliefs, values, traditions, language preferences, and health practices of the communities that we serve and to apply that knowledge to produce positive health outcomes. We also recognize that each of us has a different way of thinking and perceiving our world and that these differences often lead to innovative solutions.
Our dedication to diversity includes a unified workforce (through training and education, recruitment, retention, and development), commitment and accountability, communication, community partnerships, and supplier diversity.
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