Clinical Social Worker Case Management

Hospital for Special Surgery • New York, NY

7d • Onsite

About The Position

How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let’s talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise How you move is why we’re here. ® Now more than ever. Get back to what you need and love to do. The possibilities are endless... Now more than ever, our guiding principles are helping us in our search for exceptional talent - candidates who align with our unique workplace culture and who want to maximize the abundant opportunities for growth and success. If this describes you then let’s talk! HSS is consistently among the top-ranked hospitals for orthopedics and rheumatology by U.S. News & World Report. As a recipient of the Magnet Award for Nursing Excellence, HSS was the first hospital in New York City to receive the distinguished designation. Whether you are early in your career or an expert in your field, you will find HSS an innovative, supportive and inclusive environment. Working with colleagues who love what they do and are deeply committed to our Mission, you too can be part of our transformation across the enterprise The Continuum of Care Clinical Social Worker incorporates the case management process of assessment, planning, implementation, coordination, monitoring and evaluation into daily practice to manage the patient's broad spectrum of needs across the continuum of care. The Clinical Social Worker applies clinical expertise and core knowledge domains of social work and case management into daily practice. Data is gathered from patient/family assessments, the interdisciplinary care team and the medical record to evaluate the patient's plan of care, progression along clinical pathways and care guidelines and discharge planning. Collaborates with the patient/ family, interdisciplinary care team, medical staff, payers, and post acute providers to facilitate and coordinate patient specific evidence-based care. Patient care is transitioned through communication and appropriate referral to the next provider of care.

Requirements

• Masters Degree in Social Work
• Current New York State LCSW NYS Screen certification
• 2 years of Social Work experience in an inpatient hospital setting including discharge planning
• Excellent verbal and written communication skills.
• Knowledge of regulatory agency standards.
• Strong problem-solving skills.
• Ability to manage multiple tasks and projects independently.
• Solution oriented.
• Ability to assess clinical and discharge needs of HSS patients prior to admission, during stay at HSS, and during the post-surgical phase of care.

Nice To Haves

• CCM
• Orthopedic Social Work/discharge planning in a hospital setting

Responsibilities

• Demonstrates knowledge and competency in care management concepts by applying the case management process to an assigned group of patients across the continuum of care. This includes assessment, planning, implementation, coordination, monitoring and evaluation of the plan of care. This swing position is responsible for covering pre-admission, post-discharge and inpatient as needed.
• Utilize clinical guidelines/pathways to match patients with most appropriate level of care for recovery. Pre-admission: Completes pre-admission psychosocial/recovery planning assessments. Documents as per policy. Inpatient: Screens patients within 24 hours of admission for recovery planning needs and subsequently develops, implements and reviews plan to meet patient’s continued care needs. Post-discharge: Address and resolve patient/family concerns that arise following discharge. Communicate and collaborate with post-acute providers to ensure quality patient care. Attend to patient needs outside general scope of services both prior to and following surgery.
• Completes assessments based on screening criteria for suicide, domestic violence, ETOH and SDOH as needed.
• Provides timely documentation in the EMR (pre-admission, within 24 hours of admission, upon change of condition or plan and every 72 hours until discharge, post-discharge) detailing the patient’s plan of care, discharge plan, changes/status of the discharge plan and support/services provided.
• Plans and carries out interventions with active participation of patient, family and healthcare team; educates patients and/or families to assist them in making informed decisions regarding treatment and discharge. Ensures that all elements critical to the plan of care and discharge plan have been communicated to the patient and family necessary.
• Provides patients with a choice of post-acute providers and documents appropriately in the EMR As applicable, participates in daily interdisciplinary rounds/care team meetings to facilitate plan of care, collaborates with healthcare team, and seeks to eliminate barriers to efficient delivery of care and timely discharge to facilitate patient throughput. Ensures that prior to discharge patients’ final discharge disposition, discharge plan and next level provider are accurate, updated and congruent.
• Acts as patient advocate to ensure that patients receive appropriate care under benefit entitlements. Identifies financial constraints affecting access to care and utilizes community resources/funding to assist in meeting patient’s needs. Provide supportive counseling to patients/families with complex psychosocial needs across the continuum. Support pre-admission, inpatient, and leadership team as necessary. Respond to patients, families, MD office, interdisciplinary team and provide rapid resolution to concerns/issues that arise following surgery.
• Collaborate with leadership to reinforce and implement initiatives and projects to enhance patient care and meet organizational needs. As applicable, incorporates identified process improvements into daily practice (QI activities and Press Ganey surveys). Maintains and develops competence through required in-service and continuing educational programs.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level