Care Transition Manager, Social Worker - PRN, Days

Texas Health Resources; Texas; On-site; USD 70,000 - 95,000; Part time

Benefits offered by this job

401k

PTO

Medical insurance

Dental insurance

Paid parental leave

Tuition reimbursement

Student loan forgiveness

Job summary

Texas Health Resources, Inc. in Allen, TX is seeking a Care Transition Manager Social Worker in Care Management to join our team. This role supports timely discharge planning and seamless transitions to appropriate levels of care, collaborating with physicians, nurses and families.

Requires a Master’s degree in social work, LMSW/LCSW on hire, CPR, and hospital social work experience. The role offers a collaborative environment and opportunities for growth within a premier health system.

Qualifications

• Master’s degree in social work is required.
• Three years hospital/medical social work experience preferred.
• One year discharge planning/care management experience required.
• Hospital case management preferred.
• LMSW or LCSW on hire; CPR required; ACM/CCM preferred.

Responsibilities

• Ensure patients are transitioned to appropriate levels of care in a timely manner.
• Review THRIL scores daily for assigned patients.
• Identify high‑risk patients based on THRIL score.
• Promote discussion to identify a PCP for patients.
• Complete Transition Evaluations within 24 hours and begin discharge planning.
• Interview patients and caregivers as part of the transition evaluation.
• Discuss transition needs and funding of post-transition care with patients and caregivers.

Skills

LMSW

LCSW

Discharge planning

Care management

CPR

Education

Master’s degree in Social Work

Job description

Care Transition Manager Social Worker - Care Management

Bring your passion to Texas Health So We Are Better + Together

Work location: Texas Health Allen, 1105 Central Expwy North, Allen, TX 75013

Work hours: PRN—830-1630, 2-4 weekend shifts plus additional weekday shifts to cover fulltime PTO

Care Transition Department highlights

• Collaborates with physicians, staff, patients, and families to determine discharge needs.
• Ensure open communication with daily Interdepartmental rounds with charge RN, physicians and CTMs to ensure all agree of discharge plan.
• Supportive experienced coworkers.

Here’s What You Need

• Master’s degree in social work required
• Three years of experience in hospital/medical social work preferred
• One year of experience of discharge planning/care management
• Hospital Case management preferred
• LMSW – Licensed Master Social Worker upon hire required or LCSW – Licensed Clinical Social Worker upon hire required and CPR -Cardiopulmonary Resuscitation upon hire required and ACM – Accredited Case Manager upon hire preferred or CCM – Certified Case Manager upon hire preferred or Other – ANCC upon hire preferred

What You Will Do

• Ensure patients are transitioned to appropriate levels of care in a timely and effective manner:
• Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients
• Identify high risk patients whose THRIL score
• Promotes discussion and assists in the identification of a primary care physician (PCP) for patients
• Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning
• Interviews and assesses patients and caregivers as part of the transition evaluation
• Identifies transition needs and discusses funding of post-transition care with patients and caregivers

Additional perks of being a Texas Health Social Worker

• Benefits include 401k, PTO, medical, dental, Paid Parental Leave, flex spending, tuition reimbursement, student Loan forgiveness as well as several other benefits.
• Delivery of high quality of patient care through nursing education, nursing research and innovations in nursing practice.
• Strong Unit Based Council (UBC).
• A supportive, team environment with outstanding opportunities for growth.
• Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more.

Entity Highlights

Texas Health Allen has served the local community and surrounding areas of Collin County since 2000. We’re an 88-bed, acute-care, full-service hospital providing exceptional care to Allen, Lucas, Fairview, McKinney, Melissa, Wylie, and the surrounding cities. We specialize in robotic and minimally invasive surgery, advanced cardiology and electrophysiology services, orthopedic and spine services, and comprehensive women’s and infants’ care. Plus, we’re an Accredited Chest Pain Center and STEMI receiving facility with more than 500 physicians practicing in more than 25 specialties. Texas Health Allen is a Joint Commission-accredited Gold Seal Certified Chest Pain facility, Level II Maternal, Level II NICU, Chest Pain Accredited, a Breast Imaging Center of Excellence and a Pathways to Excellence-designated hospital. You belong here.

Do you still have questions or concerns? Feel free to email your questions to [e-mail].