About Job
- On the basis of preliminary risk screening, assesses patients’ and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
- Documentation in the medical record is legible and conforms to hospital department policies and procedures including but not limited to screening, initial discharge plan, change of condition updates and final discharge plan.
- Promotes the Hospital Case Management team concept with discharge planning activities as requested and/or assessed. Maintains close communication with post-acute care providers. Accountable for readmission assessments, risk stratification review and action planning. Uses proactive measures towards comprehensive discharge planning.
- Screens and coordinates all SNF and Rehab facility referrals as deemed appropriate. Provides consultation to team members regarding clinical needs as deemed appropriate.
- Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system
- Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.
- Provides intervention in cases involving child abuse/neglect, domestic violence, elderly abuse, institutional abuse and sexual assault.
- Serves as a resource person and provides counselling and intervention related to treatment decisions and end-of-life issues.
- Participates in the development and implementation of policies and procedures for the Case Management program.
- Assesses the patient's behavioral health needs in collaboration with physician, psychiatrists, and other members of the mental health team. Provides counseling, crisis intervention, and psychosocial assessments to patients/families with appropriate medical staff supervision.
- Strong organizational, time management, crucial conversation, problem solving and critical thinking skills required
- One (1) year Social Work Experience preferred
- One (1) year experience in a healthcare setting preferred
- ACM, CCM, C-SWCM or ACSW certification preferred
Professional Field



Patient Focus
Diagnoses
Avoidant Personality Disorder
Issues
Sexual Abuse
Therapeutic Approach
Methodologies
ECT
Modalities
Families
Individuals
Practice Specifics
Populations
Victims of Crime/Abuse (VOC/VOA)
Settings
In-patient Non-Psychiatric
In-patient Psychiatric
Private Practice
Research Facilities/Labs/Clinical Trials
Residential Treatment Facilities (RTC)
Schools
Substance Abuse Treatment Facilities
Home Health/In-home
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