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UVA Health · 4 months ago

Social Work Case Manager - Internal Traveler Program

Virginia, United States

Full-time

Onsite

Entry, Mid Level

$26.23/hr - $41.97/hr

1+ years exp

UVA Health is a world-class Magnet Recognized academic medical center and health system. They are seeking a Social Work Case Manager to manage complex psychosocial and economic barriers to patient progression, ensuring that interventions are rendered respectfully to diverse populations.

Health CareHospitalMedical

Responsibilities

Identifies patient and/or families requiring coordination of continuing care or community support members of the care team. Reviews medical records, attends rounds, and responds to patient’s needs. Applies knowledge based on professional experience

Understands and adheres to the practice standards consistent with patient progression and its contribution to the strategic plan

Works collaboratively with the RN Case Manager and the treatment team members to develop and coordinate a safe, timely and appropriate discharge plan across the care continuum, addressing psychosocial barriers, with multiple resource dependent level of care options that comply with regulations and laws regarding patient/family participation with planning and choice

Coordinates post-acute discharges for complex patients in collaboration with Care Management Discharge Manager

Identifies the need for and conducts in a timely fashion patient family meetings that result in decisions regarding advance directives, comfort measures, power of attorney, guardianship, conservatorship, and goals of care

Completes initial psychosocial screen of patients and families as indicated. Serves as the lead in addressing psychosocial needs of patients relating to social determinants of health, barriers to equal access to healthcare, and patient progression; this includes obtaining charity and financial resources, legal guardianship, adoptions, psychiatric referrals, and competency determination

Provides referrals for post-acute transitions to/for LTACH, SNF, IRF, LTC , HH and DME

Conducts practice consistent with social work ethical principles, adhering to standards set forth from NASW and ACMA Case Management practice standards

Identifies the need for and conducts family meetings that result in comfort, treatment and discharge planning decisions, and other important outcomes

Leads Care Coordination/Interdisciplinary Rounds and documents

Advocates for patient care and timely discharge plan

Works with people and agencies in the community to improve responsiveness, capabilities, alignment, and evaluation of services to patients and families

Utilizes age-appropriate assessments and interventions during all client contacts

Collaborate with Risk Management, Patient Relations, Utilization Management, the Ethics Committee and other departments for ethical issues and utilizes the NASW Code of Ethics in appropriate decision-making

Demonstrates flexibility and partnership with the care management team members to ensure the needs of patients are met

Assists patients and families in understanding their illness and treatments options, consequences to various treatments or refusal of treatment, and necessary levels of care, including acute, subacute, and community services

Assists patients and families in communicating with treatment team

Educates hospital staff on patient psychosocial needs

In addition to the above job responsibilities, other duties may be assigned

Qualification

Of Social WorkDischarge planning experienceLMSW/LCSW licensureACMA certificationCultural humilityPatient advocacyCollaboration skillsCommunication skillsAttention to detail