Social Worker MSW Care Mgmt - FT - HPW

About the role

Assesses, intervenes, and plans appropriate discharge based on patient's clinical, social and functional needs. Integrates assessment using information related to cultural, clinical, ethnic, age as well as other factors into plan of care in order to implement transition plans. Acts as an active member of the care management team in the discharge planning process identifying complicated social and financial factors and barriers to appropriate and timely discharge. Refers patients/families and care givers to appropriate resources regarding abuse/neglect/domestic violence, alcohol and substance abuse. MINIMUM REQUIREMENTS Education: Master's degree in Social Work (MSW). Experience : One year experience in hospital case management or healthcare. Other Credentials : Social Worker - Licensed 4 hours of Stroke related Continuing Education contact hours annually if assigned to: Critical Care, Intermediate Care Unit, Emergency Department, Neuro Units, Cardiology Inpatient at Hopewell, Peds ED, PACU, Interventional Radiology, CNI, Observation Knowledge and Skills: Excellent communication, conflict management, organizational and planning skills. Special Training: Clinical training in a medical/clinical environment; knowledge of spreadsheet and word processing software, case management and patient information systems. Mental, Behavioral and Emotional Abilities: Must be comfortable working with diverse age ranges and populations. ESSENTIAL FUNCTIONS Documents clinical record, comprehensive assessment of patient needs including barriers to timely discharge, clinical interventions, support and appropriate community resources according to policy and utilizing recognized format, such as, assessment, intervention, and plan. Documents clinical record appropriate interventions including assessment, plans, and referrals in the discharge planning process. Uses culturally competent skills to assess individual patient needs and refers to appropriate professional staff when necessary. Identifies barriers and plans for intervention to overcome or lessen barriers to achieve outcome as evidenced by treatment plan. Collaborates, educates and assists health care team to identify social and financial barriers that delay appropriate transitions through multidisciplinary rounds, length of stay meetings, and medical record documentation. Documents in clinical record all referrals and clinical interventions related to abuse, neglect, domestic violence, alcohol and substance abuse, crisis intervention. Performs educational sessions for health care team related to abuse/neglect issues and reporting of same. Documents staff interventions in clinical record. Completes mental health /psych assessments when appropriate. Advocates for appropriate services for all patients with payor and providers of post-acute care service, community service and other services in order to optimize patient outcome. Participates in staff development and performance improvement program activities to increase self knowledge, staff and colleague awareness of bio-psycho-social issues and functioning, improve departmental and systems design and functioning, and meet regulatory requirements. Attends and participates in regular departmental performance programs, staff meetings, and hospital wide committees to analyze and respond to issues significant to social work services and to identify opportunities for improvement. May perform follow up service as needed to measure clinical outcomes. Performs other duties as assigned. PHYSICAL DEMANDS AND WORK ENVIRONMENT Frequent physical demands include: Standing , Walking , Carry objects , Keyboard use/repetitive motion Occasional physical demands include: Sitting , Climbing (e.g., stairs or ladders) , Push/Pull , Twisting , Bending , Reaching forward , Reaching overhead , Squat/kneel/crawl , Wrist position deviation , Pinching/fine motor a