LMSW-Acute Care Coord NE B
Acute Care Coordination
Full-time FTE 0.9 -1.0
8 a.m.-5 p.m., includes weekends
Masters Degree Required
BLS for Healthcare Providers required
2-4 years experience required
To coordinate and facilitate patient care progression throughout the continuum. To work collaboratively and maintain active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management. To manage all aspects of discharge planning for assigned patients and ensure patients are discharged timely. To refer patients/families and caregivers to appropriate resources regarding abuse/neglect/domestic violence/complex care. To keep abreast of regulatory requirements. To maintain close communication and collaboration with physician advisors.
All team members are responsible for bringing life to our Purpose Statement – Inspire health. Serve with compassion. Be the difference – through every action and every interaction at work.
Participates in discharge planning activities for patients with complex medical issues, in order to ensure a timely discharge and to provide appropriate linkage with post-acute care providers. Accountable for appropriate levels of care and length of stay focus. Works collaboratively with the Nurse Care Coordinator in the discharge planning process. Assumes primary responsibility for identifying complicating social and financial factors and barriers to discharge.
Deals with families exhibiting complex family dynamics that impact directly on patient care and transitions of care. Communicates with acute care coordinators and other professionals regarding the discharge planning status of all patients referred/assessed.
Promotes the Acute Care Coordination Team concept with discharge planning activities as requested and/or assessed. Maintains close communication with post-acute care providers. Accountable for readmission assessments, risk stratification and action planning. Uses proactive measures towards comprehensive discharge planning.
Screens and coordinates all SNF and Rehab facility referrals as deemed appropriate. Provides consultation to team members regarding clinical needs as deemed appropriate.
On the basis of preliminary risk screening, assesses patients' and family's psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.
Provides intervention in cases involving child abuse/neglect, domestic violence, elderly abuse, institutional abuse and sexual assault.
Serves as a resource person and provides counselling and intervention related to treatment decisions and end-of-life issues.
Participates in the development and implementation of policies and procedures for the Case Management program.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system.
Education: Master's in Social Work required.
Experience: 3 years' social work experience required.
License, Registry, or Certification Required: Currently licensed as a Licensed Master Social Worker (LMSW) by the South Carolina Board of Social Work Examiners or currently licensed as a Licensed Independent Social Worker (LISW) by the South Carolina Board of Social Work Examiners. Current BLS (Basic Life Support for Healthcare Providers) required prior to start date directly through the American Red Cross, the American Heart Association, or the military. (To register: Blended Learning or In Person BLS through the American Red Cross; or Classroom or Skills Session BLS through the American Heart Association. Certification must include an in-person skills session.
Knowledge/Skills/Abilities: Knowledge of Health Systems Management, Complex Discharge Planning, Readmission Prevention. Knowledge of Healthcare Reform, government and third party reimbursement systems and contracts. Knowledge of regulatory mandates. Strong organizational, time management, crucial conversation, problem solving and critical thinking skills. Firm understanding of pathways, procedures, and governmental regulations.
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