Social Work Case Manager Day Shift - Allegheny Valley Hospital

General Overview
This job collaborates with the interdisciplinary team of providers, clinicians, health plans, and external partners while advocating for patients and families/caregivers to coordinate care across the continuum. The incumbent is an integral member of the Care Management team that works to improve the quality of care, patient experience, and the health of populations and individuals by focusing on the social determinants of health impacting wellness.

• Contributes to and/or completes initial and ongoing comprehensive assessment. Provides interventions and implements recommendations after engaging patients and their caregivers/families. Focuses on the individual s risk related to social determinants of health to assure successful coordination of care across the continuum. (30%)
• Collaborates to provide the safest transition plan for assigned patients (Inpatient/Observation/ED) to ensure a timely discharge and provide appropriate connection with post-discharge care providers and community-based resources. (25%)
• Educates patient, family/caregiver and physician regarding most appropriate level of care post discharge and how to access community support. Advocates for the patient, family/caregiver through effectively communicating with interdisciplinary team members, payers and post-acute partners to assure the safest transition. (20%)
• Serves as a resource to provide counseling and intervention related to treatment decisions and end-of-life issues. Drives collaborative conversations to establish goals of care. Provides crisis interventions in cases involving Child Abuse and Neglect, Domestic Violence, Adult and Older Adult Abuse, Institutional Abuse Sexual Assault, Mental Health Disorders, Substance Use Disorders, and Identification of a Surrogate Decision Maker/Guardianship. (15%)
• Promotes individual professional growth and development through certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%)
• Supports Department based goals that contribute to the success of the organization. (5%)
• Other duties as assigned.

Company
Allegheny Health Network



Job Description

$10,000 sign on bonus available

General Overview
This job collaborates with the interdisciplinary team of providers, clinicians, health plans, and external partners while advocating for patients and families/caregivers to coordinate care across the continuum. The incumbent is an integral member of the Care Management team that works to improve the quality of care, patient experience, and the health of populations and individuals by focusing on the social determinants of health impacting wellness.

Essential Responsibilities

• Contributes to and/or completes initial and ongoing comprehensive assessment. Provides interventions and implements recommendations after engaging patients and their caregivers/families. Focuses on the individual s risk related to social determinants of health to assure successful coordination of care across the continuum. (30%)
• Collaborates to provide the safest transition plan for assigned patients (Inpatient/Observation/ED) to ensure a timely discharge and provide appropriate connection with post-discharge care providers and community-based resources. (25%)
• Educates patient, family/caregiver and physician regarding most appropriate level of care post discharge and how to access community support. Advocates for the patient, family/caregiver through effectively communicating with interdisciplinary team members, payers and post-acute partners to assure the safest transition. (20%)
• Serves as a resource to provide counseling and intervention related to treatment decisions and end-of-life issues. Drives collaborative conversations to establish goals of care. Provides crisis interventions in cases involving Child Abuse and Neglect, Domestic Violence, Adult and Older Adult Abuse, Institutional Abuse Sexual Assault, Mental Health Disorders, Substance Use Disorders, and Identification of a Surrogate Decision Maker/Guardianship. (15%)
• Promotes individual professional growth and development through certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%)
• Supports Department based goals that contribute to the success of the organization. (5%)
• Other duties as assigned.

Qualifications
Minimum

• Experience in a hospital or health care setting

• None