Job Description:

Full Time 40weekly hours, day shift

Case Management

Responsible for utilization management, case management, and discharge planning.

Job Summary

As a member of the Cooperative Care Team, collaboratively assesses patient's post-hospital needs, implements discharge planning, addresses psychosocial needs of the patient and/or family on a daily basis and provides consultation to entire health care team.

Principal Duties and Responsibilities

The following is a summary of the major functions of this individual's job. He or she may perform other duties, both major and minor, which are not mentioned below, and specific functions may change from time to time.

1. Assesses patient's medical condition by review of medical record and consultation with health care team members to determine appropriate options for continuing care and evaluates patient need for counseling and support services making referrals when indicated.

2. Interviews patients and family members to obtain social history relevant to medical problems and discharge planning needs.

3. Participates in formulation of the plan of care, by evaluating appropriate community resources, utilizing socioeconomic status of the patient to ensure that appropriate post-hospital care is arranged in a timely way that satisfies the patient/family and prevents adverse psychological or financial outcome.

4. Counsels every patient and/or family member in their caseload including but not limited to:

1) understanding, accepting and following medical recommendations and

2) alleviating anxieties related to illness, disability or uncertain future.

5. Arranges for appropriate post-hospital care including but not limited to: home health, long-term care in a nursing facility, rehabilitation, sub-acute care, and/or private care givers at home.

6. Determines patient eligibility for assistance and refers to appropriate agencies.

7. Ensures hospital compliance with regulations governing discharges to appropriate levels of care and/or transfers to other hospitals.

8. Consults with physicians hospital staff, and community agencies when requested.

9. Investigates presence of and requirements for programs and services in the community, which can be utilized by patients and/or family members.

10. Recognizes indicators of abuse, neglect and exploitation of adults, children and elders, ensures appropriate reporting to authorities and works in cooperation with protective service agencies to address medical and emotional needs of victims.

11. Develops and maintains good working relationships with Cooperative Care Team, hospital and medical staff, and personnel from community health, welfare and social agencies.

12. Demonstrates knowledge of growth and development and coordinates case management process for the age specific population.

Minimum Education, Training and Experience Required

• Masters of Science in Social Work

• License in Social Work required (CSW)