Care Manager - Social Worker

GBMC HealthCare; Baltimore (MD); On-site; USD 58,000 - 94,000; Full time

Job summary

GBMC HealthCare in Baltimore, MD seeks a Social Worker to assess and intervene for seamless post-discharge care. You will interview patients and families, facilitate family meetings, and coordinate continuing care with home health and social services to support effective treatments.

The role requires a Master's in Social Work, Maryland LMSW/LCSW licensure, and 1–3 years of discharge planning experience, working in a multidisciplinary team to ensure timely, patient-centered care.

Qualifications

• Master's degree in Social Work; equivalent experience considered.
• Licensed in Maryland as LMSW or LCSW.
• 1–3 years hospital discharge planning experience preferred.

Responsibilities

• Interview patients and family members/caregivers to identify needs.
• Facilitate family meetings to develop continuing care plans.
• Assess psychosocial needs and promote treatment plan adherence.
• Educate patients and families about community resources and rights.
• Coordinate complex care plans with home health, social services, rehab and mental health providers.

Skills

Cultural competency

Active listening

Open-ended questioning

Empathy

Interviewing

Counseling

Motivational interviewing

EMR proficiency

Education

Master of Social Work

Maryland LMSW or LCSW licensure

Tools

EMR systems

Job description

The Social Worker in the Continuing Care Department is an integral member of a hospital patient’s care team, responsible for assessing and intervening to ensure the effective continuation of a patient’s care after discharge from the hospital. The social worker will be assigned to a unit or units, which may include medical, surgical, intensive care, OB/Maternity, pediatric, and/or Emergency Department, and will work closely with physicians, nurses, and other practitioners on the assigned unit. Social Worker is responsible for interviewing hospital patients and family members/caregivers; facilitating family meetings to identify needs and develop continuing care plan; assessing psychosocial needs; counseling patients and family members to promote effective coping and treatment plan compliance. Other duties include assessing knowledge deficits; educating patients and family members about community resources, rights and responsibilities, advance directives, end-of-life care issues, health insurance, and navigating the health care system. The Social Worker coordinates complex care plans involving a wide range of internal and external services including home health, social services, rehabilitation, and mental health providers; advocates for patients to receive needed resources and services. Functions as part of a multidisciplinary team. As opportunities arise, the Social Worker will participate in department and hospital initiatives related to process improvement and patient care.

Education

Masters’ in Social Work; equivalent experience or certification considered

Licensures/Certifications

• Licensed in Maryland as a LMSW or LCSW

Experience

1-3 years prior social work experience in a hospital, nursing care facility or other health care setting preferably doing discharge planning work

Skills

• Cultural competency and willingness to work with patients of many different racial, national, ethnic, and religious backgrounds as well as different age groups and socioeconomic statuses.
• Basic computer skills (electronic medical record training is provided)
• Interview skills including active listening, open-ended questioning, and empathy
• Assessment skills to quickly develop thorough assessments and care plans
• Skill in, or willingness to learn, counseling and motivational interviewing techniques
• Willingness to engage with difficult or noncompliant patients or family members; willingness to discuss topics such as end of life care or substance abuse
• Ability to self-direct and negotiate competing priorities
• Ability to develop a wide-ranging working knowledge of services, referral processes and criteria, medical terms and needs, etc. (training is provided)
• Ability to work in a fast-paced environment; desire to engage with change processes and work closely with multi-disciplinary teams

Patient & Workplace Safety

• Employee has knowledge and understanding of patient and workforce safety as it relates to job duties.

Patient Population

• Demonstrates competency in the delivery of care and applies the knowledge to meet age-specific needs if applicable.

Pay Range

$58,488.99 - $93,582.39

Final salary offer will be based on the candidate’s qualifications, education, experience and alignment with our organizational needs.

Equal Employment Opportunity

GBMC HealthCare and its affiliates are Equal Opportunity employers. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.