Care Transition Manager, SW; PRN

Texas Health Resources; Plano (TX); In loco; USD 60.000 - 90.000; Tempo pieno

Vantaggi offerti da questo lavoro

401k

Employee Assistance Program (EAP)

Discount Programs

Descrizione del lavoro

Texas Health Resources in Plano is seeking a Care Transition Manager SW to coordinate transitions from hospital to appropriate care levels. This role emphasizes timely discharges, THRIL score monitoring, and collaboration with a multidisciplinary team to ensure patient-centered care.

The position requires a Master’s in Social Work, state licensure (LMSW/LCSW), CPR, and preferred ACM/CCM or ANCC credentials, with flexible PRN daytime hours and potential weekend coverage.

Competenze

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

Mansioni

• Ensure patients are transitioned to appropriate levels of care in a timely and effective manner.
• Review Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients.
• Identify high risk patients whose THRIL score is elevated.
• Promote discussion and assist in the identification of a primary care physician (PCP) for patients.
• Complete Transition Evaluations on patients within 24 hours of identification and begin discharge planning.
• Interview and assess patients and caregivers as part of the transition evaluation.
• Identify transition needs and discuss funding of post-transition care with patients and caregivers.

Conoscenze

Hospital/medical social work

Discharge planning / care management

Formazione

Master’s degree in social work

LMSW or LCSW licensure

CPR certification

ACM or CCM certification preferred

ANCC certification preferred

Descrizione del lavoro

Care Transition Manager SW (Social Worker) - Case Management

Bring your passion to Texas Health so we are Better + Together!

Work location: Texas Health Plano, 6200 West Parker Road, Plano TX 75093

Work hours: PRN - Flexible, M-F and weekends. 8a-5p. Two holidays per year required

Care Management Highlights:

• Flexible daytime hours

• Opportunity to work with a diverse group of highly educated professionals

• Care coordination with focus on timely discharges

• Ability to pick your own schedule

• Multidisciplinary team focus

• Team oriented with focus on providing compassionate patient centered care

• Evidence based practice

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, Employee Assistance Program (EAP), Discount Programs, as well as other benefits.

• Delivery of high-quality patient care

• Strong Unit Based Council (UBC).

• A supportive, team environment with outstanding opportunities for growth.

Entity Highlights

Texas Health Presbyterian Hospital Plano is a 366-bed, Magnet-designated hospital and recognized clinical leader, providing technologically advanced care to Plano, Frisco and surrounding communities since 1991. This full-service facility features a full range of specialties including emergency medicine, cardiology, adult and adolescent behavioral health, pediatrics, an adult intensive care unit, state of the art and technologically advanced surgical services and a Level III NICU. Texas Health Plano has more than 1,600 employees and over 1,360 physicians on its medical staff in more than 65 specialties. The hospital is an Advanced Level III Trauma Facility, accredited Chest Pain Center by The Joint Commission, named 'Best Place to Have a Baby' in Collin County and a Gold-Level Mother Friendly business. Texas Health Plano is the recipient of the Disease Specific Care Certifications from the Joint Commission in Chest Pain, Joint Replacement - Hip and Joint Replacement - Knee and an Advanced Certification as a Primary Stroke Center. We invite you to join us in furthering your career and our accomplishments and philosophy of excellence.

Do you still have questions or concerns?

Feel free to email your questions to [e-mail] .

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Texas Health requires a resume when an application is submitted.Employment opportunities are only reflective of wholly owned Texas Health Resources entities.

We are an Equal Opportunity Employer and do not discriminate against any employees or applicant for employment because of race, color, sex, age, national origin, religion, sexual orientation, gender identity, status as a veteran, and basis of disability or any other federal, state or local protected class.