Social Worker MSW - Care Management - HPW - FT - Day

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Capital Health is the region's leader in providing progressive, quality patient care with significant investments in our exceptional physicians, nurses and staff, as well as advanced technology. Capital Health is a dynamic health care resource accredited by the DNV that includes two hospitals, an outpatient center, satellite ED, and an expansive network of primary and specialty care. Capital Health Medical Group is made up of more than 600 physicians and other providers who offer primary and specialty care, as well as hospital-based services, to patients throughout the region. Capital Health recognizes that attracting the best talent is key to our strategy and success as an organization. As a result, we aim for flexibility in structuring competitive compensation offers to ensure we can attract the best candidates. The listed pay range or pay rate reflects compensation for a full-time equivalent (1.0 FTE) position. Actual compensation may differ depending on assigned hours and position status (e.g., part-time). Pay Range: $34.99 - $45.71 Scheduled Weekly Hours: 40 Position Overview Social Worker MSW Care Management JOB CODE:20200 FLSA Exemption Status: Non-Exempt SUMMARY (BASIC PURPOSE OF THE JOB) Assesses, diagnoses, intervenes with and plans for social work services related to patient and family bio-psycho-social needs and behaviors. Integrates assessment using information related to cultural, clinical, ethnic, age and other factors into plan of care in order to implement transition plans and treatments. Acts as active team member in the discharge planning process and has primary responsibility for identifying complicated social and financial factors and barriers to appropriate discharge. Assures patient is referred to available, appropriate social and financial resources post discharge in order to transition patient efficiently and achieve the desired outcome. Refers patients/families and care givers to appropriate resources regarding abuse/neglect/domestic violence, alcohol and substance abuse. Performs appropriate clinical interventions related to grief counseling, bereavement, adjustment, crisis intervention in order to support the process of transition planning and increase patient/family coping skills. MINIMUM REQUIREMENTS Education: Master's degree in Social Work (MSW). Experience: One year experience in a clinical setting performing clinical social work preferred. Other Credentials: Social Worker - Licensed 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. Usual Work Day:8 Hours 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. Counsels staff and patient/family on conflict management in health care setting and monitors reaction and need for ongoing intervention. 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. Assists in data collection and information gathering on patient care issues, program and systems analysis in order to co