Social Worker BSW

Bachelor Of Social Work (BSW) Case Manager

The Bachelor of Social Work (BSW) Case Manager plays a pivotal role in maintaining the quality of care patients receive during medical center hospitalization and post discharge while ensuring the organization is fully reimbursed. The BSW Case Manager (CM) must have a high level of expertise and skill to create highly effective strategies for short term and long term goals in order to prevent readmissions and address unpredictable situations.

BSW CM must be proficient in planning, executing and monitoring effectiveness of the care provided to ensure timely transition through the continuum of care. Educating and consulting with the physician and the health care team to ensure timely and appropriate level of care is achieved. This requires effective skills in conflict resolution, decision making and team building. The BSW Case Manager practices in accordance with the care management process utilizing tools, standards, models, goals and objectives, and performance improvement concepts.

The BSW Case Manager provides pertinent clinical data to outside agencies as needed to assure compliance with their requirements and represents the organization professionally. The ability to analyze, evaluate and distribute resources and educational information to ensure understanding of services to all educational level is key to the role. The social worker is responsible for assessing the patient's psychosocial-spiritual needs, education and discharge planning needs.

Other duties and responsibilities include:

• Complete and document a standard social work psychosocial-spiritual assessment to:
  Eliminate barriers to treatment and discharge, increase patient/family satisfaction, improve appropriate utilization of resources.
• Serve as the lead in obtaining financial and other resources for patients and families in need.
• Identify the need for and conduct family meetings, with or without the physician, that result in understanding, comfort, decision-making, and other important outcomes, such as discharge.
• Integrate relevant theories of family dynamics, crisis intervention, strengths based, solution focused, and meaning of illness into everyday casework.
• Summarize a patient and family situation concisely, with helpful guidance to non-social work staff members about recommendations for actions to be taken and barriers to discharge.
• Facilitates discharge planning for patients i.e. extended care placements, other facility transfers, and home care arrangements in collaboration with the health care team.
• Actively participate in care coordination efforts to successfully identify high-risk factors and respond appropriately so that key information, next steps and avoidable days are captured and documented. Is an active participant in the daily care coordination meetings.
• Accepts accountability for the clinical outcomes that the Discharge Planning role can facilitate.
• Maintains timely, clear and concise documentation in all required systems.
• Provides pertinent clinical data to designated outside agencies to assure compliance with their requirements.
• Assures compliance with regulatory requirements and acts a resource/liaison to physicians and medical staff regarding all aspects of Case Management activities.
• During Care Coordination Rounds, BSW CM communicates with the health care team a patient-centered plan that is needs based, appropriate to patient resources, timely and addresses the risk of readmission.
• Builds professional relationships with patient, families, facilities and resources to address conflict resolution with positive outcomes.
• Completes all documentation and data entry requirements. Identifies high risk population and addresses opportunities for intervention.
• Willingly and…