Community Social Work Care Manager

All the benefits and perks you need for you and your family :

Benefits from Day One : Medical, Dental, Vision Insurance, Life Insurance, Disability Insurance

Paid Time Off from Day One

403-B Retirement Plan

4 Weeks 100% Paid Parental Leave

Career Development

Whole Person Well-being Resources

Mental Health Resources and Support

Our promise to you :

Joining UChicago Medicine AdventHealth is about being part of something bigger. Its about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. UChicago Medicine AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule : Full Time Monday-Friday 8a-4 : 30p with possible weekend coverage

Location : 500 REMINGTON BLVD, Bolingbrook, 60440

The community you'll be caring for : UChicago Medicine AdventHealth Bolingbrook Hospital

The role you'll contribute :

The Community Social Work Care Manager will provide support to law enforcement officers by providing referral to community resources for individuals and families in contact with police. The role bridges the gap between law enforcement and community services, helping address issues such as mental health crisis, substance use, homelessness, domestic violence and youth and family conflict. The Community Social Work Care Manager intervenes with patients who have complex psychosocial needs, require assistance with eligibility determination for social programs, funding sources and qualify for community assistance from a variety of special assistance programs and agencies, and / or require assistance with transitions of care or discharge planning. In addition, offer crisis intervention to patients and families with psychosocial needs and coordinates and facilitates the development of a discharge plan of care for high-risk patient populations. This role will receive referrals for individuals from at-risk populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other members of the care team). The Social Work Care Manager, in collaboration with the patient / family, care manager nurses, nurses, physicians and the interdisciplinary team, ensures patient-centered care coordination through the continuum of care. The Community Social Work Care Manager ensures efficient and cost-effective care through appropriate resources monitoring and clinical care escalations. The Social Worker is under the general supervision of the Care Management Supervisor or Manager and is responsible for patient evaluations of post-hospital needs; development of a transition of care plans and initiation of the implementation of the transitions of care plans prior to the discharge of the patient. The Social Work Care Manager is responsible for optimal patient flow / throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety, readmission prevention and length of stay management. The Community Social Work Care Manager communicates daily with the interdisciplinary team during daily multidisciplinary rounds. Care coordination, discharge planning, transitions of care planning and are core competencies of this role. The Social Work Care Manager facilitates the collaborative management of patient care across the continuum, intervening to remove barriers to timely and efficient care delivery and reimbursement. The Social Work Care Manager provides education to nurses, physicians and the interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning and care coordination. The Community Social Work Care Manager is knowledgeable of post-hospital care and services available to the patient including, but not limited to the following : Home Health, Infusion Services, Durable Medical Equipment, Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based Organizations. The Social Work Care Manager adheres to departmental and system goals, objectives, policies and procedures and ensures quality patient care and regulatory compliance. Actively participates in outstanding customer service and accepts responsibility in maintaining relationships that are equally respectful to all.

The value you'll bring to the team :

Provides grief counseling, disease adjustment support, crisis intervention, goals of care planning support, and de-escalation services for patients as appropriate.

Assesses patients and families wholistically for discharge planning needs in the inpatient, observation and / or emergency departments, including prior functioning, support systems, financial, and psychosocial in a timely fashion to avoid delays in discharge planning.

Reviews the medical record, including medications, history and physical, labs, and progress notes and incorporates the clinical, social, and financial factors into the transition of care plan.

Develops discharge plans with appropriate contingency plans throughout the hospital stay to ensure timely care coordination and progression of care, making arrangements for post-acute care services and facilities as well as community care for social needs.

Leverages technology and follows standard work and best practices to communicate with post-acute care services and facilities to ensure patient care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.

Actively participates in multi-disciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for all assigned patients to identify resources necessary at discharge and ensure a timely transition, escalating care delays to leadership as appropriate.

Communicates with and educates patients and families regarding emotional, social, and financial impacts of illness and mobilizes family / community resources to meet identified needs while advocating for patient and family empowerment in making health care decisions and accessing needed services.

Organizes and facilitates patient and family care conferences with the multidisciplinary team.

Documents discharge planning evaluation, ongoing assessment, discharge plans, MDRs, barriers to progression of care, avoidable days, and patient and family needs according to standard work.

Provides patient and family advocacy, and support patients choice and patient rights during hospitalization.

Communicates with Payors patients needs for authorization for post-acute care as needed.

Assesses readmitted patients for the patients and familys perceived reasons for the readmission.

Develop and implement safety and service plans in collaboration with clients and officers

Follow-up with individuals and families after initial police contact to ensure ongoing support and connection to resources

Participates in case review meeting with law enforcement and community service agencies

Other duties as assigned

Qualifications

The expertise and experience you'll need to succeed :

Master's Required

Four or more years of Work Experience Required

Excellent interpersonal communication and negotiation skills

Critical thinking and problem-solving skills

Psychosocial assessment skills

Customer service skills

Ability to work and communicate with people of all social, economic, and cultural backgrounds; be flexible, open-minded and adaptable to change

Effective organizational skills

Computer proficiency with Outlook e-mail and electronic medical records

Flexible in a complex and changing healthcare environment

Understanding of pre-acute and post-acute venues of care and post-acute community resources

Maintains a current working knowledge of services available in the local community, particularly services available to patients with limited or non-existent payment resources

Strong interview, assessment, and organizational skills

Leadership skills

Data analysis skills

Current working knowledge of discharge planning, utilization management, care management, performance improvement and managed care reimbursement

Knowledge of state and federal guidelines pertinent to Care Management

Ability to identify appropriate community resources and to work collaboratively with patients, families, multidisciplinary team and community agencies to achieve desired patient outcomes

Licensed Social Worker (LSW) Preferred

Clinical Social Worker License (LCSW) Preferred

Certified Social Worker (CSW) Preferred

Licensed Masters Social Worker - Advanced Practice (LMSW-AP) Preferred

Licensed Master Social Worker (LMSW) Preferred

Lic Baccalaureate SocialWorker (LBSW) Preferred

Certified Advanced Practice Social Worker (CAPSW) Preferred

Certified Independent Social Worker (CISW) Preferred

Accredited Case Manager (ACM) Preferred

Certified Case Manager (CCM) Preferred

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances. The salary range reflects the anticipated base pay range for this position. Individual compensation is determined based on skills, experience and other relevant factors within this pay range. The minimums and maximums for each position may vary based on geographical location.

Category : Case Management

Organization : UChicago Medicine AdventHealth Bolingbrook

Schedule : Full-time

Shift : 1 - Day

Req ID : 25043520

We are an equal opportunity employer and do not tolerate discrimination based on race, color, creed, religion, national origin, sex, marital status, age or disability / handicap with respect to recruitment, selection, placement, promotion, wages, benefits and other terms and conditions of employment.