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    Certification Details
  • Licensed Clinical Social Worker (LCSW)
  • Basic Life Support (BLS)
    Job Details
  • Responsible for coordinating and implementing post-discharge plans in coordination with the Case Managers through the use of Extended Care Information Network (ECIN).
  • Assists with advocacy and referrals to other community resources.
  • Obtains, reviews and analyzes information relative to discharge planning in accordance with hospital policy.
  • Assesses/reassesses patient's clinical and psychosocial status, premorbid status, community services utilized, and diagnosis and treatment plan per Case Management referral.
  • Identifies community resources needed and facilitates referrals to agencies or programs for assistance as needed.
  • Educates patient and/or family on community resources available for assistance.
  • Facilitates discharge planning working with patient, families and treatment team making needed referrals/arrangements and documenting actions.
  • Documents actions taken in progress notes and/or discharge planning-assessment form from initial visit through to discharge.
  • Demonstrates professionalism in actions and job performance in accordance with mission and the social work code of ethics.
  • Demonstrates and understands the needs of neonatal, pediatric, adolescent, geriatric age groups and implements discharge plans tailored to age-specific needs.
  • Demonstrates sensitivity toward different age groups, ethnic, cultural and disabling human diversity and human development.
  • Conforms to standards of patient and family confidentiality according to hospital and NASW standards and HIPAA.
  • Assesses patient's physical, psychosocial, cultural and spiritual needs through observation, interview, review of records and interfacing with interdisciplinary team and caregivers to ensure appropriate referrals.
  • Reevaluates and makes adjustments to discharge plan as patient's condition changes.
  • Ensures appropriate arrangements for post-hospital care are made before discharge to avoid unnecessary delays.
  • Assesses patient/family emotional, social and financial needs and assists in setting up community resources to meet these needs.
  • Provides support to patients and families coping with changing medical conditions.
  • Confirms treatment goals and anticipated plan of care through discussions with treatment team and review of documentation.
  • Communicates treatment goals or best practices to treatment team including physician.
  • Uses ECIN to facilitate electronic referrals for discharge planning.
  • Uses supportive crisis intervention including illness, grief/loss in decision making process.
  • Consults and communicates with manager regarding difficult practice issues.
  • Adheres to state and federal regulations pertaining to discharge.
  • Implements discharge plan in accordance with physician direction and patient/caregiver agreement.
  • Assesses patient/family learning style and appropriately teaches and documents understanding.
  • Collaborates with interdisciplinary team to develop and implement holistic, individualized plan of care.
    Job Requirements
  • Knowledge of community resources used for discharge planning.
  • Knowledge of hospital operations.
  • Excellent communication and presentation skills.
  • Knowledge of third party payment systems, Medicare/Medicaid programs.
  • Ability to multi-task, set priorities and maintain organization.
  • Computer skills.
    Additional Details
  • Works in collaboration with Case Management Coordinator, Home Care Coordinator and Utilization Review to ensure seamless and timely delivery of services.
  • Maintains updated referral resource lists.
  • Assesses, coordinates and evaluates discharge readiness with Case Management and discusses variances with treatment team as needed.
  • Participates in Family Conferences and Interdisciplinary Team Meetings as needed with Case Manager.
  • Reviews variance in plan of care concerning discharge planning with Case Management and/or supervisor as needed.
  • Completes daily discharge planning verbal rounds with Case Management department to prioritize daily activities.
  • Initiates discharge planning day one of referral to assist with length of stay management.
  • Works with third party payors and Case Management to satisfy discharge planning needs and obtain approval of post discharge plans.
  • Implements plan and communicates possible options for discharge with regard to insurance benefits and contracted providers.
  • Makes appropriate outside agency referrals.
  • Follows through with all aspects of discharge planning across continuum of care.
  • Provides supervision/preceptorship for department medical social workers pursuing advanced licensure.
  • Performs SBIRT evaluations, biopsychosocial assessments and crisis evaluations.
  • Maintains current knowledge base of community services through continuing education.
  • Float may be required to any CommonSpirit location within 60 miles of original assignment or float zone.
  • Float assignments may include duties outside of original assignment job requirements in accordance with CommonSpirit policy.

Read the full job description and apply online on the recuiter's web-site

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