Hospital Corporation of America
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Medical Social Worker - PRN
at Hospital Corporation of America
St. David's South Austin Medical Center is part of St. David's HealthCare, one of the largest health systems in Texas, which was recognized with a Malcolm Baldrige National Quality Award in 2014. St. David's South Austin Medical Center is an acute care facility with 316 beds, offering a range of complex specialties and sub-specialties, including a nationally accredited oncology program with the area's only adult bone marrow transplant program; a trauma program that includes all of the capabilities and programmatic elements of a Level II trauma center to treat the most severely injured and critical patients; a comprehensive cardiac program; full-service maternity and newborn care with Level I and II nurseries; and two full-service emergency centers in the communities of Bee Cave and Bastrop.
The Social Worker will evaluate the psychosocial needs of patients and family support systems and will coordinate appropriate discharge plans for identified patient populations. The Social Worker acts as a liaison between the facility and resources external to the organization. He/she will facilitate implementing timely discharge plans and facilitate follow-up to anticipated post-acute interventions identified in the plan of care. The Social Worker will provide crisis intervention and support. The Social Worker will assist the Case Manager in facilitating patient movement across the continuum of care and will identify and track barriers to patient throughput.
- Performs a comprehensive assessment of psychosocial needs of assigned patients; Involves patient, family/responsible/significant others, develops, implements, monitors and revises plan of care in collaboration with the interdisciplinary team
- Assesses patients discharge needs and facilitates the provision of services necessary to meet identified needs; performs home health referrals, intermediate care and skilled nursing facility referrals, assist patients with medication acquisition, facilitates follow up appointments, arranges public transportation, etc.
- Evaluates suspected abuse and neglect referrals; makes official reports to state and regulatory or legal agencies as required by statue or facility policy
- Develops an individual plan of care for recurring patients to include education related to accessing healthcare services at the appropriate level of care; preventative education, and community based resources, provides assistance with access to medication assistance programs
- Provides education to the under-resourced patient/family of potential and available resources; identifies needs, coordinates the development of realistic plans which include patient/family centered goals, facilitates implementing plan, and performs follow-up evaluation
- In collaboration with the interdisciplinary team, develops, implements, evaluates, revises as needed, a discharge plan to include identified psychosocial and discharge needs
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Participates with the interdisciplinary team to ensure psychosocial and discharge needs are addressed; plan, interventions and patient/family/MD concurrence will be documented
- Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
- Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
- Makes appropriate referrals, after collaboration with the Case Manager, to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Facilitates patient throughput with an ongoing focus on quality outcomes and an efficient transition between levels of care
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
- Provides psychosocial support to patients and families through crises intervention
- Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
- Acts as an advocate for identified needs and makes appropriate referrals; abuse and neglect, substance abuse/overdose, homelessness, post-partum patients < 17 years of age, fetal demise, mother-baby bonding, adoptions, guardianship, etc.
- Acts as a liaison between the facility and community resources to enhance community outreach coordination; establishes and maintains resource database, educates peers and patients on resources, performs community outreach as directed
- Tracks and trends variances barriers related to access to care; makes recommendations and develops action plans to improve processes and systems
- Adheres to established policy and procedure and standard of care; escalates issues through the Chain of Command
Master or Bachelor's of Social Work with current state licensure; CMSW, LCSW or LCP preferred
Minimum requirements for accrediting bodies, JCAHO, state and regulatory requirements related to service delivery in the facility
Three years Social Work experience; acute care case management experience preferred
Certification in Social Work or Case Management, preferred
Ability to establish and maintain collaborative and effective working relationships
Ability to communicate effectively in oral, written and electronic formats
Demonstrates analytical and critical thinking abilities with pro-active decision-making and negotiation skills
Demonstrates an ability to perform specific competencies as identified