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Northeast Georgia Health System in Gainesville, GA is seeking a Case Management Social Worker to provide hospital-based medical social work services. You will assess patients across ages, collaborate with the care team, and develop discharge plans addressing social, financial, and environmental needs.
Responsibilities include crisis intervention, advocacy, and coordinating placements and community resources to support safe, timely transitions of care.
Behavioral Health, Counseling, and Clergy
12 Hr Morning - Afternoon
Northeast Georgia Health System is rooted in a foundation of improving the health of our communities.
The Case Management Social Worker is responsible for the provision of medical social work services to patients receiving care in the hospital setting. Assesses the social, psychological, cultural, environmental, and financial situation, as well as disposition needs for each referred patient. Collaborates with RN Case Manager, patients, families, healthcare team members, and community agencies to develop and implement plans to address identified needs. Evaluates effectiveness of plans and initiates change as needed. Uses crisis intervention, problem solving model, community organization, and advocacy skills in identifying needs and resources in the hospital and community. This position will come in contact with patients in the neonate, infant, child, adolescent, adult, and geriatric age groups; Employees will perform clinical duties in accordance with population specific guidelines and adhere to National Patient Safety Guidelines. Provides cross coverage for all Social Workers as required across all settings in the care continuum, including weekend rotation (as needed).
Uses a family systems theory framework to gather information, to include, patient's social, psychological, cultural, environmental and financial situation. Identified legal, financial, social, educational, and environmental factors which may affect medical care and/or discharge plans. Informs team members of critical information that will affect patient's stay while in the hospital and / or discharge plan.
Assesses and assures appropriate reporting of any potential/actual abusive relationship, such as child/adult abuse, neglect or domestic violence.
Assesses upon request an psychiatric/ substance abuse disorders and initiates or assists in arranging appropriate intervention and referrals for treatment upon discharge.
Uses SBIRT techniques which allows for an evidence-based approach to identifying patients who use alcohol and other drugs at risky levels with the goal of reducing and preventing related health consequences, disease, accidents and injuries.
Expedites the discharge plan through excellent networking and team skills within the patient's expected length of stay per working DRG. Provides patient advocacy and ensures patient's Freedom of Choice and Medicare's Important Message. Attends multidisciplinary rounds to ensure timely communication with the team.
Receives referrals for appropriate placement (NH, SNF, Assisted Living, LTAC, Acute Rehab etc., from Case Manager or Care Coordinator). Reviews patient information from the electronic record. Interviews patient and/or family for preference of facilities and secures signatures on Freedom of Choice form. Completes DMA 6 where required and obtains appropriate signatures. Updates any changes in insurance, demographic information, patient level of care, etc. Ensures appropriate discharge documentation is available to accompany patient to the facility. Stays in touch with the team, patient and family regarding post acute plans. Coordinates appropriate transportation.
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