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Description
Inspire health. Serve with compassion. Be the difference.
Job Summary
Coordinates and facilitates the plan of care for the applicable department and interdisciplinary health care team. Responsible for advising the medical staff of available services to ensure delivery of care is provided in the most cost effective manner in the least restrictive environment. Leads treatment team in the delivery and adjustment of services across the continuum of care (inpatient to outpatient). Ensures patient/family successful completion of the care plan with continuous supervision and monitoring. Implements corrective action to reduce noncompliance by assessment, education, counseling and modifications to the plan of care. Coordinates and adjusts care plans across the continuum of care (inpatient to outpatient).Accountabilities
DISCHARGE PLANNING
1.\u00A0 Screens patients using high risk indicators including but not limited to, frequent hospitalization, inadequate support systems, homelessness, abuse, neglect, exploitation, and domestic violence.
2. Assesses for immediate discharge planning needs and develops and coordinates a discharge plan as determined by the patient's medical condition, level of independence, functional capacity, family/social support systems, and financial resources.
3.\u00A0 Assesses for long term and/or future patient care needs by identifying probable changes in level of independence or functional capacity in collaboration with patient/family and interdisciplinary care team.\u00A0 Provide information and education on community resources to empower patient/family decision making.
4.\u00A0 Communicates the discharge plan to patient/family and the interdisciplinary care team by timely documentation in the medical record, active participation in discharge rounds, and/or verbal dialogue as appropriate.\u00A0 Collaborates with patient and family to develop the discharge plan. - 50%
DOCUMENTATION
Documentation in the medical record is legible and conforms to hospital and department policies and procedures including but not limited to discharge plan, weekly status updates or whenever changes in the plan occur. - 25%
BEHAVIORAL HEALTH ASSESSMENT AND MANAGEMENT
1.\u00A0 Assesses patient's behavioral health needs in collaboration with physicians, psychiatrists, and other members of the mental health team.
2.\u00A0 Provides counseling, crisis intervention, and\u00A0psychological\u00A0assessments\u00A0to patients/families with appropriate medical staff supervision.
3.\u00A0 Collaborates with internal and external resources to develop a short term and long term plan of care as appropriate. - 25%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Master's Degree Social Work or equivalent in related field
- 1 year - Healthcare setting in which complex discharge planning and management of a 40+ caseload required
Required Certification/Registrations/Licenses
- Licensed Bachelor Social Work - LBSW
- LSW - Licensed Social Worker - LLSW
Work Shift
Day (United States of America)Location
3010 Farrow Rd ColumbiaFacility
3250 Sickle Cell 3010 Farrow 300ADepartment
32501000 Sickle Cell 3010 Farrow 200-Practice OperationsShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
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Job Summary
Coordinates and facilitates the plan of care for the applicable department and interdisciplinary health care team. Responsible for advising the medical staff of available services to ensure delivery of care is provided in the most cost effective manner in the least restrictive environment. Leads treatment team in the delivery and adjustment of services across the continuum of care (inpatient to outpatient). Ensures patient/family successful completion of the care plan with continuous supervision and monitoring. Implements corrective action to reduce noncompliance by assessment, education, counseling and modifications to the plan of care. Coordinates and adjusts care plans across the continuum of care (inpatient to outpatient).Accountabilities
DISCHARGE PLANNING
1.\u00A0 Screens patients using high risk indicators including but not limited to, frequent hospitalization, inadequate support systems, homelessness, abuse, neglect, exploitation, and domestic violence.
2. Assesses for immediate discharge planning needs and develops and coordinates a discharge plan as determined by the patient's medical condition, level of independence, functional capacity, family/social support systems, and financial resources.
3.\u00A0 Assesses for long term and/or future patient care needs by identifying probable changes in level of independence or functional capacity in collaboration with patient/family and interdisciplinary care team.\u00A0 Provide information and education on community resources to empower patient/family decision making.
4.\u00A0 Communicates the discharge plan to patient/family and the interdisciplinary care team by timely documentation in the medical record, active participation in discharge rounds, and/or verbal dialogue as appropriate.\u00A0 Collaborates with patient and family to develop the discharge plan. - 50%
DOCUMENTATION
Documentation in the medical record is legible and conforms to hospital and department policies and procedures including but not limited to discharge plan, weekly status updates or whenever changes in the plan occur. - 25%
BEHAVIORAL HEALTH ASSESSMENT AND MANAGEMENT
1.\u00A0 Assesses patient's behavioral health needs in collaboration with physicians, psychiatrists, and other members of the mental health team.
2.\u00A0 Provides counseling, crisis intervention, and\u00A0psychological\u00A0assessments\u00A0to patients/families with appropriate medical staff supervision.
3.\u00A0 Collaborates with internal and external resources to develop a short term and long term plan of care as appropriate. - 25%
Supervisory/Management Responsibilities
This is a non-management job that will report to a supervisor, manager, director or executive.
Minimum Requirements
- Master's Degree Social Work or equivalent in related field
- 1 year - Healthcare setting in which complex discharge planning and management of a 40+ caseload required
Required Certification/Registrations/Licenses
- Licensed Bachelor Social Work - LBSW
- LSW - Licensed Social Worker - LLSW
Work Shift
Day (United States of America)Location
3010 Farrow Rd ColumbiaFacility
3250 Sickle Cell 3010 Farrow 300ADepartment
32501000 Sickle Cell 3010 Farrow 200-Practice OperationsShare your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health.
