Social Worker MSW

US:NV:Carson City Case Management

Full Time Day Shift

Summary

• This individual is responsible to facilitate care through the continuum utilizing effective resource coordination to promote optimal access to care balancing the patients’ resources and right to self-determination
• The overall responsibility to assess the patient for transition of care needs and risk for readmission
• This individual will be able to conduct complex psycho-social assessments and provide interventions to assist with throughput, safe discharges and avoid readmissions
• Has focus on complex social and post-acute care services

Qualifications

Required

• Master in Social Work from accredited school of Social Work
• Excellent interpersonal, written and verbal communication skills
• Demonstrated organizational skills, critical thinking and problem solving skills and computer literacy
• Unrestricted licensure in the State of Nevada in one of the following:
• Licensed Social Worker (LSW)
• Licensed Masters Social Worker (LMSW)
• Licensed Clinical Social Worker (LCSW)

Preferred

• Two (2) years of acute care coordination experience
• Ability to obtain Accredited Case Manager (ACM) certification

Essential Functions

• Transition Management
• Completes initial /comprehensive assessment within 24 hours of admission, including anticipated transition (discharge) plan
• Provides psycho-social assessment and intervention for patients identified with behavioral health issues, lack of social support systems, financial barriers, end of life and plan of care adherence
• Ensures plan of care and interventions are implemented and communicated to health care team, patient/family and post-acute care providers
• Complete timely, accurate and concise documentation in the Electronic Medical Record
• Care Coordination
• Screens high risk and referred patients for psycho-social issues/barriers, that may impact the transition plan and intervenes as appropriate
• Assists with adoption/abuse/neglect cases and reports to appropriate external agencies as required
• Collaborates with patient/family/health care team to ensure patient preferences and choices are taken into consideration within the limitations of available resources
• Education
• Ensure patient/ family receive education appropriate to their specific discharge plan
• Provides education to medical and nursing staff regarding relevant issues related to transition plan
• Precepts new staff members and acts as resource to all staff
• Compliance
• Ensures compliance with local, state and federal regulations and accreditation requirements
• Operates within social work scope of practice as defined by the state licensing board
• Participates in department Quality improvement initiatives
• Complex Case Management
• Completes clear, concise and accurate initial/discharge planning/complex psycho-social assessments and reassessments per departmental guidelines (assessments within 24 hours of admission, reassessments every 3 days or as needed for change)
• Escalates barriers to transition planning per departmental escalation plan
• Completes post-acute referrals within 3 days of admission
• Schedules and facilitates complex case patient/family conferences as needed (at a minimum of weekly)
• Performs other related duties as assigned.