Social Worker, Case Manager

Evaluate patients' ability to progress throughout the continuum of care Collaborate with physicians, nursing, and multidisciplinary care team members to ensure timely and appropriate patient management Assess patients' biopsychosocial needs and psychosocial risk factors Communicate with patients, families, interdisciplinary care team members, and other appropriate parties about care plans, treatment goals, concerns, and problems Identify and resolve barriers to care progression and advocate for patients Intervene regarding emotional, social, and financial consequences of illness or disability Provide counseling and interventions related to treatment and end-of-life decisions Advocate for patient and family empowerment and independence in healthcare decisions Provide discharge planning and continuity of care in acute and post-acute settings Initiate and facilitate referrals to clinics, home healthcare, hospice, SNF, acute rehab, LTAC, TCM, medical equipment, and supplies Coordinate discharge planning, post-discharge services, patient transitions, and ongoing community care Document discharge planning information in medical records Coordinate services and act as a liaison between patients, families, and interdisciplinary healthcare members Perform other duties as assigned Requirements Basic Life Support certification upon start 1 year of experience in clinical care or clinical case management Master's Degree in Social Work (MSW) One year of previous inpatient hospital case management and case management discharge planning experience is highly preferred Core Competencies Demonstrates expertise in clinical case management, including patient assessment, discharge planning, and coordination of care across multidisciplinary teams. Proficient in advocating for patient needs and facilitating referrals to ensure continuity of care. Highest-signal resume keywords Clinical Case Management Discharge Planning Patient Advocacy Biopsychosocial Assessment Basic Life Support Certification ATS Optimization Keywords Hard Skills Patient Assessment Care Coordination Documentation in Medical Records Counseling Intervention Strategies Soft Skills Communication Collaboration Problem-Solving Empathy Interpersonal Skills Certifications & Qualifications Basic Life Support Certification Industry Keywords Continuum of Care Interdisciplinary Care Team Inpatient Hospital Experience Social Work Healthcare Decision-Making #J-18808-Ljbffr Jobtailor