Care Transition Manager Social Worker LMSW PRN
Care Transition Manager Social Worker LMSW PRN
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Salary Not Disclosed
1 Vacancy
Job Description
Care Transition Manager Social Worker PRN
LMSW or LCSW
Great opportunity - use your clinical knowledge in an administrative role!
Work location: Texas Health Southwest Ft. Worth 6100 Harris Parkway Fort Worth TX 76132 will also assist with Texas Health Clearfork
Work hours: PRN on an as needed basis Some weekends: (2) 8-hour Weekend shifts per month; Between 24 to 40 hours/week between 8:00AM-5:00PM mainly Monday-Friday cover for leaves of absence vacation illnesses.
Care Transition Department highlights:
Care Transition management - will float to various specialty areas as needed
Magnet status Level II Trauma facility Stroke & Chest pain certified Hip & Knee Orthopedics certified.
Heres What You Need
Masters Degree Social Work Required (Individuals hired as a CTSW prior to May 11 2017 will be grandfathered to the CTSW position with BSW at the entity they were employed at on May 11 2017)
3 Years experience in hospital/medical social work Preferred
1 Year discharge planning/care management Preferred
LMSW - Licensed Master Social Worker Upon Hire Required Or
LCSW - Licensed Clinical Social Worker Upon Hire Required
CPR - Cardiopulmonary Resuscitation Upon Hire Required
ACM - Accredited Case Manager Upon Hire Preferred Or
CCM - Certified Case Manager Upon Hire Preferred Or
Other ANCC Upon Hire Preferred
Working knowledge of medical necessity criteria preferred
- Knowledge of Microsoft Outlook and Office (Word Excel)
- Customer service skills Psychosocial and crisis intervention skills
- Ability to engage in complex clinical decision-making Critical thinking analysis and conflict resolution skills
- Strong oral and written communication skills
- Strong commitment to interdisciplinary collaboration
- Flexible scheduling as necessary
- Ability to prioritize and meet deadlines
What You Will Do
Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner:
Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients and collaborates with the interdisciplinary team to identify high risk patients whose THRIL score may not have indicated appropriately.
Promotes discussion and assists in the identification of a primary care physician (PCP) for patients without a PCP
Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning.
Interviews and assesses patients and caregivers as part of the transition evaluation and as needed.
Identifies transition needs and discusses funding of post-transition care with patients and caregivers.
Identifies Geometric Mean Length of Stay (GMLOS) and updates the Anticipated Date of Discharge (ADOD) as necessary while considering excess days risk.
Identifies community resources and service needs and facilitates appropriate referrals as needed.
Communicates with the multidisciplinary team (physicians nursing therapy) patient family and post-acute care stakeholders in order to coordinate care.
Educates patients caregivers and the multidisciplinary team regarding available post-acute care services and needs.
Facilitates care conferences for complex transitions placement and palliative care needs.
Proactively identifies patients who no longer meet continued stay criteria and communicates with the physician team.
Attempts to schedule PCP specialist or clinic follow up appointments for patients.
Responsible for compliance with documentation guidelines and regulatory agency requirements:
Complies with all documentation requirements and documents all activities in the electronic health record.
Adheres to compliance requirements for delivery of various documents (e.g. HINN IMM MOON letters).
Has a working knowledge of the following documents: Advanced Directives Medical Power of Attorney Application for Temporary Mental Health Treatment and out-of-hospital Do Not Resuscitate.
Participates in Joint Commission and other survey readiness activities
Additional perks of being a Texas Health Care Transition Manager Social Worker
Benefits include 401k discounts in the cafeteria and free parking.
A supportive team environment with outstanding opportunities for growth.
Explore our Texas Health careers site for info like Benefits Job Listings by Category recent Awards weve won and more.
#LI-JH1
Required Experience:
Manager
Employment Type
Full-Time
