About Job

Certification Details
Licensed Clinical Social Worker (LCSW)

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 any 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.
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 patients' 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
Licensed Clinical Social Worker (LCSW) credential required.
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 with Case Manager as needed.
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 Requirements: Floating may be required to any CommonSpirit location within sixty (60) miles of the original assignment location or CommonSpirit-identified “float zone”.
Float assignments may include duties outside of original assignment job requirements (including skill set) in accordance with CommonSpirit policy.