Care Management Social Worker

AdventHealth; Kissimmee (FL); Sur place; USD 33 000 - 62 000; Plein temps

Avantages offerts par ce poste

Benefits from Day One: Medical, Dental

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Well-being Resources

Mental Health Resources and Support

Pet Benefits

Résumé du poste

AdventHealth in Kissimmee, Florida is seeking a Discharge Planning professional to lead inpatient discharge coordination on a night shift. Master’s degree required with 2+ years in care management and 2+ years in social work preferred.

You will assess needs, develop discharge plans, collaborate with the care team, and communicate with families to ensure timely transitions. The role emphasizes advocacy, resource mobilization, and effective use of EMR and Outlook within a dynamic hospital setting.

Qualifications

• Excellent interpersonal communication and negotiation skills
• Critical thinking and problem-solving
• Psychosocial assessment skills
• Customer service skills
• Ability to work with diverse backgrounds; adaptable to change
• Effective organizational skills
• Computer proficiency with Outlook e-mail and EMRs
• Flexible in a complex healthcare environment
• Understanding of pre- and post-acute care venues and resources
• Knowledge of community resources for patients with limited resources

Responsabilités

• Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.
• Assesses patients’ and families’ wholistically for discharge planning needs in inpatient, observation and/or ED settings, including support systems and psychosocial factors.
• Reviews medical records and integrates clinical, social, and financial factors into discharge plans.
• Develops discharge plans with contingency plans for timely care coordination and progression of care.
• Leverages technology and standard work to communicate post-acute care needs and ensure complete medical records and accurate discharge reconciliation.
• Participates in multi-disciplinary rounds to review status and resources for discharge.
• Educates patients and families about illness impacts and mobilizes community resources; advocates for patient rights.
• Organizes and facilitates patient and family care conferences with the multidisciplinary team.
• Documents discharge planning evaluations, assessments, plans, barriers, and MDRs.
• Provides patient advocacy and supports patient choices during hospitalization.
• Communicates with Payors regarding post-acute authorization as needed.
• Assesses readmitted patients for reasons and coordinates care accordingly.
• Other duties as assigned.

Connaissances

Interpersonal communication

Negotiation

Critical thinking

Problem solving

Organizational skills

Outlook proficiency

EMR knowledge

Flexibility

Care management knowledge

Formation

Master's degree

Outils

Outlook

Electronic Medical Records (EMR)

Description du poste

Our promise to you:

Joining AdventHealth is about being part of something bigger. It’s about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

All the benefits and perks you need for you and your family:

• Benefits from Day One: Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance
• Paid Time Off from Day One
• 403-B Retirement Plan
• 4 Weeks 100% Paid Parental Leave
• Career Development
• Whole Person Well-being Resources
• Mental Health Resources and Support
• Pet Benefits

Schedule

Full time

Shift

Night (United States of America)

Address

2450 N ORANGE BLOSSOM TRL

City

KISSIMMEE

State

Florida

Postal Code

34744

Job Description

Schedule: 3/12's, Nights

• Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.
• Assesses patients’ and families’ wholistically for discharge planning needs in the inpatient, observation and/or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.
• Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.
• Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.
• Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
• Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate.
• Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family/community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.
• Organizes and facilitates patient and family care conferences with the multidisciplinary team.
• Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work.
• Provides patient and family advocacy, and support patient’s choice and patient rights during hospitalization.
• Communicates with Payors patient’s needs for authorization for post-acute care as needed.
• Assesses readmitted patients for the patient’s and family’s perceived reasons for the readmission.
• Other duties as assigned.

Knowledge, Skills, and Abilities

• Excellent interpersonal communication and negotiation skills [Required]
• Critical thinking and problem-solving skills [Required]
• Psychosocial assessment skills [Required]
• Customer service skills [Required]
• Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change [Required]
• Effective organizational skills [Required]
• Computer proficiency with Outlook e-mail and electronic medical records [Required]
• Flexible in a complex and changing healthcare environment [Required]
• Understanding of pre-acute and post-acute venues of care and post-acute community resources [Required]
• Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources [Required]
• Strong interview, assessment, and organizational skills [Required]
• Leadership skills [Required]
• Data analysis skills [Required]
• Current working knowledge of discharge planning, utilization management, care management, performance improvement and managed care reimbursement [Preferred]
• Knowledge of state and federal guidelines pertinent to Care Management [Preferred]
• Ability to identify appropriate community resources and to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes [Preferred]
• Knowledge of state and federal guidelines pertinent to care management [Preferred]

Education

• Master's [Required]

Work Experience

• 2+ care management experience [Preferred]
• 2+ social work [Required]

Additional Information

Additional Licensure or certification requirements may apply depending on the specific unit or state in which this position is located. Please consult the relevant credential grid for detailed information regarding these requirements

Licenses and Certifications

• Accredited Case Manager (ACM) [Preferred]
• Certified Case Manager (CCM) [Preferred]

Physical Requirements

(Please click the link below to view work requirements)

Physical Requirements - https://tinyurl.com/msy4mja2

Pay Range

$23.94 - $44.53

Background Screening Requirement (Florida Law)

Certain positions are subject to Florida Level 2 background screening, including fingerprinting, as required by state law.

Applicants may review general information about Florida’s background screening requirements at the Florida Care Provider Background Screening Clearinghouse: https://info.flclearinghouse.com/

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.