SOCIAL WORKER MSW

Carson Tahoe Health; Carson City (NV); On-site; USD 70,000 - 85,000; Full time

Job summary

Carson Tahoe Health in Carson City, NV is seeking a Nursing Support professional in full-time day shift to support case management and transition of care. You will assess needs, coordinate resources and ensure safe discharges while promoting patient self-determination.

The role emphasizes psycho-social assessments, throughput optimization and preventing readmissions, with a strong focus on social and post-acute services.

Qualifications

• This position requires a Master in Social Work from an accredited school.
• Excellent interpersonal, written and verbal communication skills.
• Demonstrated organizational, critical thinking and problem solving abilities.
• Unrestricted licensure in Nevada as LSW, LMSW, or LCSW.

Responsibilities

• Transition management: complete initial/comprehensive assessment within 24 hours of admission and plan discharge.
• Provide psycho-social assessment and interventions for patients with behavioral health issues, lack of social support, financial barriers, end of life, and adherence to plan.
• Ensure care plans and interventions are communicated to the health care team, patient/family, and post-acute providers.
• Complete timely, accurate documentation in the Electronic Medical Record.
• Care coordination: screen high risk patients for psycho-social issues and barriers; assist with cases and report to external agencies as required.
• Education: educate patient/family on discharge plan and train medical/nursing staff on transition issues; precept new staff.
• Compliance: ensure adherence to local/state/federal regulations and accreditation; operate within social work scope; participate in quality initiatives.
• Complex case management: perform assessments and reassessments per guidelines; escalate barriers; complete post-acute referrals within 3 days; schedule weekly family conferences.

Skills

Interpersonal skills

Written communication

Verbal communication

Organizational skills

Critical thinking

Problem solving

Computer literacy

Education

Master of Social Work (MSW)

Licensed Social Worker (LSW)

Licensed Masters Social Worker (LMSW)

Licensed Clinical Social Worker (LCSW)

Tools

Electronic Medical Record (EMR)

Job description

US:NV:Carson City | Nursing Support | Full Time

Description

US:NV:Carson City Case Management

Full Time Day Shift

Summary

This individual is responsible to facilitate care through the continuum utilizing effective resource coordination to promote optimal access to care balancing the patients’ resources and right to self-determination

The overall responsibility to assess the patient for transition of care needs and risk for readmission

This individual will be able to conduct complex psycho-social assessments and provide interventions to assist with throughput, safe discharges and avoid readmissions

Has focus on complex social and post-acute care services

Qualifications

Required:

• Master in Social Work from accredited school of Social Work
  • Excellent interpersonal, written and verbal communication skills
  • Demonstrated organizational skills, critical thinking and problem solving skills and computer literacy
  • Unrestricted licensure in the State of Nevada in one of the following:
    • Licensed Social Worker (LSW)
    • Licensed Masters Social Worker (LMSW)
    • Licensed Clinical Social Worker (LCSW)

Preferred:

Two (2) years of acute care coordination experience

Ability to obtain Accredited Case Manager (ACM) certification

Essential Functions

• Transition Management
  • Completes initial /comprehensive assessment within 24 hours of admission, including anticipated transition (discharge) plan
  • Provides psycho-social assessment and intervention for patients identified with behavioral health issues, lack of social support systems, financial barriers, end of life and plan of care adherence
  • Ensures plan of care and interventions are implemented and communicated to health care team, patient/family and post-acute care providers
  • Complete timely, accurate and concise documentation in the Electronic Medical Record
• Care Coordination
  • Screens high risk and referred patients for psycho-social issues/barriers, that may impact the transition plan and intervenes as appropriate
  • Assists with adoption/abuse/neglect cases and reports to appropriate external agencies as required
  • Collaborates with patient/family/health care team to ensure patient preferences and choices are taken into consideration within the limitations of available resources
• Education
  • Ensure patient/ family receive education appropriate to their specific discharge plan
  • Provides education to medical and nursing staff regarding relevant issues related to transition plan
  • Precepts new staff members and acts as resource to all staff
• Compliance
  • Ensures compliance with local, state and federal regulations and accreditation requirements
  • Operates within social work scope of practice as defined by the state licensing board
  • Participates in department Quality improvement initiatives
• Complex Case Management
  • Completes clear, concise and accurate initial/discharge planning/complex psycho-social assessments and reassessments per departmental guidelines (assessments within 24 hours of admission, reassessments every 3 days or as needed for change)
  • Escalates barriers to transition planning per departmental escalation plan
  • Completes post-acute referrals within 3 days of admission
  • Schedules and facilitates complex case patient/family conferences as needed (at a minimum of weekly)
• Performs other related duties as assigned.