Per Diem SW/CM

Beth Israel Deaconess Medical Center; USA; Vor Ort; USD 85.000 - 110.000; Vollzeit

Zusammenfassung

Beth Israel Deaconess Medical Center is seeking a Clinical Social Worker (MSW) to perform comprehensive psychosocial assessments, care coordination, discharge planning, and resource management for patients across the continuum of care.

The LCSW Case Manager will assess social determinants of health, identify barriers to treatment and safe transitions, and advocate for patients and families to achieve optimal outcomes.

Qualifikationen

• Master's Degree in Social Work (MSW) from a CSWE-accredited program.
• Licensed Clinical Social Worker (LCSW) in the Commonwealth of Massachusetts.
• Minimum of two (2) years of post-licensure social work experience in healthcare, hospital, behavioral health, rehabilitation, or care management setting.

Aufgaben

• Conduct comprehensive psychosocial assessments to identify patient and family strengths, needs, risks, and barriers to care.
• Collaborate with physicians, nurses, care managers, therapists, and community providers to develop and implement discharge and transition plans.
• Coordinate post-acute services including skilled nursing facilities, rehabilitation programs, home health services, hospice and palliative care, behavioral health treatment, and community-based supports.
• Develop comprehensive discharge plans and coordinate family meetings for complex issues.
• Maintain accurate documentation in the electronic medical record and ensure compliance with CMS, Joint Commission, state and federal regulations.

Ausbildung

Master's Degree in Social Work (MSW)

Jobbeschreibung

When you join the growing BILH team, you're not just taking a job, you're making a difference in people's lives.

CLINICAL SOCIAL WORKER (MSW)

Job Description:

Job Profile Summary

Beth Israel Lahey Health and Mount Auburn Hospital are devoted to consistently promoting a culture of Wellbeing, Empathy, Collaboration, Accountability, Respect, and Equity as outlined in our organization's WE CARE values which can be reviewed here Mission, Vision & Values | Mount Auburn Hospital.

The Licensed Clinical Social Worker (LCSW) Case Manager is responsible for providing comprehensive psychosocial assessment, care coordination, discharge planning, and resource management for patients across the continuum of care. As a key member of the interdisciplinary healthcare team, the LCSW Case Manager assesses social determinants of health, identifies barriers to treatment and discharge, facilitates transitions of care, and advocates for patients and families to ensure safe, efficient, and patient-centered outcomes. This role combines advanced clinical social work practice with case management principles to address psychosocial, emotional, financial, environmental, and behavioral health needs that impact patient health and recovery. This role reports to the manager of the care transitions team.

Job Description

ESSENTIAL DUTIES & RESPONSIBILITIES (including but not limited to):

Clinical Social Work Practice

• Conduct comprehensive psychosocial assessments to identify patient and family strengths, needs, risks, and barriers to care.
• Evaluate the impact of medical, behavioral health, substance use, financial, cultural, and environmental factors on patient care and recovery.
• Provide crisis intervention, supportive counseling, grief counseling, and emotional support to patients and families.
• Assess for abuse, neglect, domestic violence, human trafficking, self-harm risk, and other safety concerns, initiating appropriate interventions and mandatory reporting as required.
• Assist patients and families in understanding illness, treatment plans, healthcare options, and community resources.

Case Management and Care Coordination

• Collaborate with physicians, nurses, care managers, therapists, and community providers to develop and implement individualized discharge and transition plans.
• Coordinate post-acute services including:
  • Skilled nursing facilities
  • Rehabilitation programs
  • Home health services
  • Hospice and palliative care
  • Behavioral health treatment
  • Substance use treatment programs
  • Community-based support services
• Facilitate timely referrals to internal and external resources.
• Participate in interdisciplinary rounds and patient care conferences.
• Monitor progression toward discharge goals and identify barriers that may delay transitions of care.

Resource Management

• Connect patients and families with community resources and benefits, including:
  • Medicaid and public assistance programs
  • Housing resources
  • Transportation services
  • Food insecurity programs
  • Financial assistance resources
  • Elder services and long-term supports
• Assist patients in accessing insurance benefits and available social services.
• Advocate for equitable access to healthcare services and community supports.

Discharge Planning

• Develop comprehensive discharge plans that support safe transitions to the next level of care.
• Coordinate family meetings when complex psychosocial or discharge planning issues exist.
• Ensure patients and caregivers understand available resources and follow-up care recommendations.
• Collaborate with community providers to promote continuity of care and reduce avoidable readmissions.

Documentation and Compliance

• Maintain accurate, timely, and complete documentation in the electronic medical record.
• Document psychosocial assessments, interventions, care plans, discharge planning activities, and patient outcomes.
• Ensure compliance with:
  • CMS Conditions of Participation
  • Joint Commission standards
  • State and federal regulations
  • Hospital policies and procedures
  • Social work ethical and professional standards

Quality and Performance Improvement

• Participate in quality improvement initiatives related to patient experience, length of stay, readmissions, and care transitions.
• Support department and organizational goals related to patient outcomes and population health.
• Contribute to process improvement activities and interdisciplinary committees.

QUALIFICATIONS:

Education Required:

• Master's Degree in Social Work (MSW) from a CSWE-accredited program.

Licensure Required:

• Licensed Clinical Social Worker (LCSW) in the Commonwealth of Massachusetts.

Experience Required:

• Minimum of two (2) years of post-licensure social work experience in a healthcare, hospital, behavioral health, rehabilitation, or care management setting.

Preferred:

• Acute care hospital experience.
• Experience in care transitions, utilization management, or discharge planning.

Certifications Preferred:

Certif