Care Transition Manager, Social Worker - PRN

Care Transition Manager Social Worker (SW)

Location:

Texas Health Dallas, 8200 Walnut Hill Lane, Dallas, TX 75231.

Work hours:

PRN;
Weekends.

• Engaged leadership team
• Manageable case load
• Team that works together to ensure work/life balance for all

• Master’s degree in social work required
• Three years of experience in hospital/medical social work preferred
• One year of experience in discharge planning/care management
• Hospital case management preferred
• LMSW – Licensed Master Social Worker upon hire required
• LCSW – Licensed Clinical Social Worker upon hire required
• CPR – Cardiopulmonary Resuscitation upon hire required
• ACM – Accredited Case Manager upon hire preferred
• CCM – Certified Case Manager upon hire preferred
• ANCC upon hire preferred

• Ensure patients are transitioned to appropriate levels of care in a timely and effective manner
• Review the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients
• Identify high‑risk patients whose THRIL score indicates elevated risk
• Promote discussion and assist in identifying a primary care physician (PCP) for patients
• Complete Transition Evaluations on patients within 24 hours of identification and begin discharge planning
• Interview and assess patients and caregivers as part of the transition evaluation
• Identify transition needs and discuss funding of post‑transition care with patients and caregivers

• Benefits include 401(k), PTO, Medical, Dental, Paid Parental Leave, Flex Spending, Tuition Reimbursement, Student Loan Forgiveness and other benefits
• Delivery of high quality patient care through nursing education, nursing research, and innovations in nursing practice
• Strong Unit Based Council (UBC)
• Supportive, team environment with outstanding opportunities for growth