Job Summary
The Care Manager - LCSW is responsible for coordinating and overseeing discharge planning, transitions of care, and case management activities to ensure optimal patient outcomes. This role involves collaborating with interdisciplinary teams, reviewing medical records for post-acute care support and collaboration with the RN Care Manager, and medical necessity, and maintaining compliance with federal, state, and accreditation standards.
Essential Functions
- Collaborates with interdisciplinary teams (IDT) to ensure effective communication and coordination of patient care, including identifying avoidable days and resolving care transition issues.
- Develops and supports discharge plans in coordination with he Care Manager, coordinating post-hospital placement and social services to meet patient needs.
- Refers cases to physicians or managers or RNs when patients do not meet established criteria, ensuring timely and appropriate interventions.
- Serves as a liaison with community agencies, maintaining relationships and facilitating seamless transitions for discharged patients.
- Facilitates interdisciplinary meetings to address patient care needs, resolve challenges, and support collaborative care planning.
- Maintains accurate and timely documentation of case management activities, including records of referrals, patient interactions, and compliance with reporting requirements.
- Identifies and appropriately refers cases to Child/Adult Protective Services, ensuring compliance with legal and ethical standards, if first person notification is done directly with the social worker. Directs others to comply with federal mandate for first person reporting. This requirement cannot be designated to another social worker
- Provides professional assistance to patients, families, and physicians regarding discharge planning and post-hospital care options.
- Performs other duties as assigned.
- Maintains regular and reliable attendance.
- Complies with all policies and standards.
Qualifications
- Bachelor's Degree in Social Work required
- Master's Degree in Social Work preferred
- 2-4 years of experience in an acute care hospital setting required
Knowledge, Skills and Abilities
- Strong understanding of case management principles, discharge planning, and transitions of care.
- Knowledge of federal, state, and Joint Commission standards related to case management.
- Excellent communication and interpersonal skills to collaborate effectively with patients, families, and interdisciplinary teams.
- Ability to assess complex situations, identify solutions, and implement care plans efficiently.
- Proficiency in electronic medical records (EMR) and documentation systems.
- Ability to plan, organize and direct the activities of others.
- Strong organizational and time management skills to prioritize tasks in a dynamic environment.
Licenses and Certifications
- LCSW- License Clinical Social Worker required or
- LMSW - Licensed Medical Social Worker - State Licensure licensed in the state of employment required
