Care Transition Social Worker: Discharge & Care Management

Texas Health Resources, Inc.; 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

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.