Social Worker Case Manager - Per Diem

MCH 452 Old Street Rd Peterborough, NH 03458, USA At MCH, you'll collaborate with a diverse and knowledgeable team, contributing to the high-quality care we provide to our community. We value your passion for patient care and teamwork. The SW Case Manager is responsible for working with patients, families and interdisciplinary care team members with the overall goal of developing transitional care plans that are patient-centered and respect patients’ individual needs, values and goals, and are developed in alignment with available resources. The SW Case Manager performs Care Coordination activities as further described below consistent with The National Association of Social Workers (NASW) Standards of Practice in Health Care Settings. Located in the scenic Monadnock Region of New Hampshire, Monadnock Community Hospital (MCH), a trusted healthcare partner in Peterborough, NH, is dedicated to enhancing the health and well‑being of our community. We provide compassionate, personalized care, from Primary Care, Inpatient & Outpatient Services, to a range of specialties such as Cardiology, Behavioral Health, Gastroenterology, Obstetrics, Ophthalmology, Orthopedics, and more. Our 24/7 emergency department, full laboratory, and radiology department round out our commitment to delivering high‑quality patient care. Driven by innovation, MCH offers cutting‑edge programs to keep the community healthy. Responsibilities: Develops and coordinates inpatient discharge plans for patients who are considered at risk for adverse outcomes (e.g., readmission, medication error, falls) as determined by the interdisciplinary care team and in collaboration with the RN UR/Case Manager and other members of the care team, such as physicians, nurses, pharmacy, therapy, Primary Care social workers, etc. Assesses all inpatients including those on the Birthing Suite and Med Surg Unit to determine the need for services post‑discharge as soon after admission as possible (preferably within one day of admission with the exception of weekends/holidays). Identifies patients who require discharge planning services through chart review and through information gathered through conversations with the interdisciplinary team and with patients and families, and through discussions at care rounds. Collaborates with the interdisciplinary team and the patient and family, as appropriate to develop a plan. Follows up with plans identified by Master’s level social workers for those patients that are hospital patients. Makes referrals to health care providers, nursing facilities and agencies to transition care to the post‑discharge. Documents all discharge planning activities in the medical record. Arranges for family meetings, as appropriate. Completes documentation as required by nursing facilities, by DHHS and others to facilitate the patient’s discharge to other care settings. Assists in identifying cost savings for treatment consistent with payor requirements and consistent with patient financial resources to mitigate cost of care (i.e., medications; equipment; post‑acute providers). Provides information and advice to outpatient areas, such as the Emergency Department and other areas where patients are identified to be in need of services, such as skilled care or home care. When providing outpatient advice, the SW Social Worker will consult with primary care social workers to determine whether patients are already under the care of MHP so that appropriate hand‑offs can be made. Participates in internal and external quality improvement activities, reports adverse events and adheres to safety practices, reports accidents/hazards and maintains equipment as outlined in hospital policies. Requirements: Education: A Bachelor’s degree in social work from a college accredited by the Council on Social Work Education is required, with preference given to a candidate that is certified and/or working towards a Master’s degree. Experience: 1–2 years experience in a hospital setting required. Required Skills: Must have excellent interpersonal skills and the ability to communicate effectively through various means with a variety of individuals, including physicians, patients, families of patients, the public and co‑workers. Good overall clinical skills required. Demonstrated ability to function well as a member of a multi‑disciplinary team required. Ability to represent the program well in interactions both inside and outside the hospital is necessary. Additional Competencies and Skills: Proficiency with Microsoft products such as Word, Excel, PowerPoint. Working Hours: This is a per diem. Competitive salary based on experience. About Our Benefits: We strive to employ and retain the most highly qualified individuals by providing equitable wages and benefits, promoting from within, and supporting the continuing education efforts of our staff. You will be valued and rewarded for the work you do here with excellent pay and outstanding benefits. At MCH, you’ll find great opportunities for career advancement as well as personal and professional growth. Free membership to local gym Positive work environment with a supportive team and opportunities for growth Reach new heights at Monadnock Community Hospital. MCH is a critical access hospital in beautiful, historic Peterborough, New Hampshire. For 100 years, we have provided outstanding care to our communities, earning a reputation for excellence that has made us one of New Hampshire’s most successful and beloved small hospitals. Join a culture of Compassion, Collaboration, Honesty, and Respect! Our employees are the heart and soul of Monadnock Community Hospital. In every department and at every level, MCH employees go above and beyond to deliver an exceptional patient experience in an atmosphere that is healthy, friendly, respectful, and personally fulfilling. About the Monadnock Region: A great place to live, work, and play. One of the best things about working at Monadnock Community Hospital is that you get to live in a community that offers an amazing quality of life. The state of New Hampshire consistently ranks in the Top Ten of all American states for its overall quality of life. Towns are small and friendly here, crime is low, schools are good, and the air and water are clean. Balance meaningful work with a great life. Here in the Monadnock Region, you can enjoy a standard of living that is hard to match anywhere. Let’s start with our mountain for which we are named. Around the 3,165 foot Mount Monadnock with 100‑mile views are forests, woods, lakes, and protected rivers providing abundant opportunities for hiking, biking, kayaking, fishing, cross‑country skiing – you name it! And if you’re into the arts, the region also offers a lively arts scene, with galleries, theatres, and concert venues. New England community spirit Family‑friendly Arts and culture Just 1.5 hours to Boston Are you ready for a great job in a great place? Are you ready for a career that supports your aspirations? Are you ready to work in the best place you’ve ever lived? Our small hospital is committed to diversity, inclusion, and equal opportunity employment. We welcome applications from individuals of all backgrounds and abilities. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, disability status, veteran status, or any other characteristic protected by law. Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws. For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr Monadnock Community Hospital