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Job Summary
Responsible for and will participate in the assessment planning implementing coordinating communicating and finalizing the discharge of the patient/resident form the hospital setting or rehab and nursing center. Works with other members of the health care team both inpatient and outpatient to advocate for and ensure appropriate aftercare and follow up.
Essential Functions
Competently gathers information using assessment skills to identify physical psychosocial financial and environmental health care needs of the patient/resident. Assess and identify appropriate resource utilization level of care and treatment options to develop a plan of care that will impact quality outcomes in a cost effective manner.
Collaborates with the patient/resident family and health care team to promote quality care prevent delay in discharge and complications to improve outcomes. Work with the patient and physician to develop a plan of care that meets their needs and will avoid duplication and or fragmentation of services. Ensure appropriate use of ancillary services providing guidance and direction and implementing modification to the plan of care as needed.
Efficiently documents assessments clinical findings completed tasks plan for treatment and progress toward goals for discharge. Keep accurate record of patient/family contact and team consultation. Works to actively facilitate an appropriate level of care for discharge and educate the patient on the progress of the discharge plan and the safety and benefits of the plan.
Monitor evaluate and coordinate referrals from multiple sources while measuring patient care outcomes interpreting reports and addressing data from sources to better serve and impact the patient and their adjustment to illness and treatment.
Actively promotes frequent communication between all team members providers patients and family members to ensure a smooth transition from one level of care to another. Share and educate on community resources support systems and available benefits. Maintain communication with providers delivering care to ensure consistency in communication to patient/resident and family.
Demonstrate self directed self motivated responsible behavior recognizing when there is a need for adjustment and flexibility in professional function. Respect confidentiality of all parties involved in the patient/resident care process and utilize the professional skills of other team members and disciplines for improvement in the discharge plan.
Qualifications
Required
Bachelors Degree Social Work: Exceptions for persons without a
social work degree can be made for those who have a human
services degree and carry a current social work
license OR
Bachelors Degree Social Work or a human services field including but not limited to Sociology Gerontology Special Education Rehabilitation Counseling and Psychology (Rehab and Nursing Centers only)
1 year of relevant experience Supervised social work experience in health care setting working directly with individuals. (Rehab and Nursing Centers only)
LIC-Bachelor Social Worker (BSW) - STATEMI State of Michigan Excludes Rehab and Nursing Centers Upon Hire required
Preferred
1 year of relevant experience skilled nursing home process and procedure
1 year of relevant experience mental health substance abuse assessment and treatment
1 year of relevant experience community resources and discharge planning
3 years of relevant experience Hospital or Nursing Home Social work
Comprehensive benefits package to meet your financial health and work/life balance goals. Learn more here.
On-demand pay program powered by Payactiv
Discounts directory with deals on the things that matter to you like restaurants phone plans spas and more!
Optional identity theft protection home and auto insurance pet insurance
Traditional and Roth retirement options with service contribution and match savings
Eligibility for benefits is determined by employment type and status
Primary Location
SITE - Pine Ridge Nursing & Rehab Center - 4368 S Cleveland Ave - StevensvilleDepartment Name
Social Services - Pine RidgeEmployment Type
Full timeShift
Day (United States of America)Weekly Scheduled Hours
40Hours of Work
8:00 a.m. to 4:30 p.m.Days Worked
Monday to FridayWeekend Frequency
Variable weekendsCURRENT COREWELL HEALTH TEAM MEMBERS Please apply through Find Jobs from your Workday team member account. This career site is for Non-Corewell Health team members only.
Corewell Health is committed to providing a safe environment for our team members patients visitors and community. We require a drug-free workplace and require team members to comply with the MMR Varicella Tdap and Influenza vaccine requirement if in an on-site or hybrid workplace category. We are committed to supporting prospective team members who require reasonable accommodations to participate in the job application process to perform the essential functions of a job or to enjoy equal benefits and privileges of employment due to a disability pregnancy or sincerely held religious belief.
Corewell Health grants equal employment opportunity to all qualified persons without regard to race color national origin sex disability age religion genetic information marital status height weight gender pregnancy sexual orientation gender identity or expression veteran status or any other legally protected category.
An interconnected collaborative culture where all are encouraged to bring their whole selves to work is vital to the health of our organization. As a health system we advocate for equity as we care for our patients our communities and each other. From workshops that develop cultural intelligence to our inclusion resource groups for people to find community and empowerment at work we are dedicated to ongoing resources that advance our values of diversity equity and inclusion in all that we do. We invite those that share in our commitment to join our team.
You may request assistance in completing the application process by calling 616.486.7447.
Full-Time