DescriptionAt ScionHealth, we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.Job Summary

Coordinates, facilitates, and executes Social Work functions with the patient population through effective collaboration and communication with the Interdisciplinary Care Transitions (ICT) team members
Follows patients throughout the care continuum, identifying and addressing psychosocial needs
Provides ongoing support and expertise through specialized application of assessment, individual treatment plans, continuous evaluation of treatment planning, case management, mediation, referral, consultation, education, and advocacy
Enhances the quality of patient management and satisfaction to promote continuity of care through the integration of the functions of case management, discharge planning, and the application of social work practices
Acts as a patient advocate, investigates and reports adverse occurrences, performs staff education related to discharge planning and psychosocial aspects of healthcare delivery
Advocates for the understanding of significant physical, biological, psychological, emotional, and environmental factors underlying patient's health issues

Essential Functions

Coordinates psychosocial activities with the Interdisciplinary Team and Physicians to provide comprehensive discharge planning
Utilizes critical thinking to develop and execute effective discharge plans
Conducts comprehensive, ongoing biopsychosocial assessments of patients and families
Serves as a patient advocate and fosters collaborative relationships to support informed decision-making
Participates in interdisciplinary patient care rounds and/or conferences
Provides patient and family education on post-hospital needs
Collaborates with clinical staff on the development and implementation of care plans
Educates patients, families, and the healthcare team on cultural, ethical, abuse/neglect, and financial matters
Refers patients and families to appropriate community resources
Applies knowledge of growth and development to provide age-appropriate support
Coordinates social services to support family functioning and healthcare utilization
Serves on division and hospital committees as needed
Arranges for post-hospital care through community institutions and agencies

Knowledge/Skills/Abilities/Expectations

Knowledge of payor practices, regulations, and reimbursement related to discharge planning
Familiarity with Medicare benefits, insurance processes, and contracts
Understanding of accreditation standards and compliance requirements
Proficiency in English; strong verbal and written communication skills
Strong critical thinking, prioritization, and time management skills
Basic computer skills, including Microsoft Office
Effective interpersonal skills with patients, families, and staff
Regular attendance required
Travel requirement: Approximately 0%
Stand: Occasionally
Walk: Occasionally
Sit: Constantly
See, talk, and hear: Constantly
Finger, handle, or feel: Constantly
Push/Pull: Occasionally
Stoop, kneel, crouch, or crawl: Occasionally
Reach with hands and arms: Occasionally
Taste or smell: None
Lift up to 10 pounds: Frequently
Lift up to 20 pounds: Occasionally
Lift more than 20 pounds: Not required
Vision requirements: Close vision, distance vision, color vision, peripheral vision, depth perception, ability to adjust focus
Hearing requirements: Ability to hear alarms, client calls, and instructions
Exposure to blood, body fluids, or tissues: None
Exposure to latex: None
Exposure to fumes, airborne particles, toxic or caustic chemicals: None
Exposure to outdoor weather, extreme heat/cold, or wet conditions: None
Risk of electrical shock, radiation, vibration, or loud noise: None
Exposure to moving mechanical parts: None