Provides psychosocial screening, assessment, and crisis management to coordinate comprehensive discharge planning for patients and families. Collaborates with interdisciplinary healthcare teams and post-acute care providers to ensure a seamless transition of care.
Requirements summary
Requires a Master's degree in Social Work and a current LMSW or LISW license from the state Board of Social Work Examiners. One year of social work experience in a healthcare setting is preferred.
Job Summary Provides screening, assessment, planning, problem resolution, resource management, counseling and crisis management as they relate to the health care and discharge planning needs of the patient/family.
Manages and collaborates in discharge planning for patients with simple and complex needs and coordinates with agencies providing post hospital care.
Functions as an interdisciplinary health care team member collaborating with other health care professionals to coordinate in the assessment of patient/family needs and development of a comprehensive plan of care, and to coordinate and facilitate resolution of patient needs.
Services are provided in accordance with accepted standards of professional practice and the policies and procedures of Prisma Health.
Essential Functions All team members are expected to be knowledgeable and compliant with Prisma Health's purpose: Inspire health.
Serve with compassion.
Be the difference On the basis of preliminary risk screening, assesses patients’ and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
Ensures documentation in the medical record is legible and conforms to hospital department policies and procedures including but not limited to screening, initial discharge plan, change of condition updates and final discharge plan.
Promotes the Hospital Case Management team concept with discharge planning activities as requested and/or assessed.
Maintains close communication with post-acute care providers.
Accountable for readmission assessments, risk stratification review and action planning.
Uses proactive measures towards comprehensive discharge planning.
Screens and coordinates all SNF and Rehab facility referrals as deemed appropriate.
Provides consultation to team members regarding clinical needs as deemed appropriate.
Advocates for patient and family empowerment and independence to make autonomous health care decisions and access needed services within the health care system Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.
Provides intervention in cases involving child abuse/neglect, domestic violence, elderly abuse, institutional abuse and sexual assault.
Serves as a resource person and provides counselling and intervention related to treatment decisions and end-of-life issues.
Participates in the development and implementation of policies and procedures for the Case Management program.
Assesses the patient's behavioral health needs in collaboration with physician, psychiatrists, and other members of the mental health team.
Provides counseling, crisis intervention, and psychosocial assessments to patients/families with appropriate medical staff supervision.
Performs other duties as assigned.
Supervisory/Management Responsibility This is a non-management job that will report to a supervisor, manager, director, or executive.
Minimum Requirements Education - Master's degree in social work Experience - One (1) year Social Work Experience preferred.
One (1) year experience in a healthcare setting preferred.
In Lieu Of NA Required Certifications, Registrations, Licenses Currently licensed as a Licensed Master Social Worker (LMSW) by the state Board of Social Work Examiners or currently licensed as a Licensed Independent Social Worker (LISW) by the state Board of Social Work Examiners.
Team members employed in this job prior to July 1, 2020, are grandfathered under prior educational and experience requirements.
In addition, team members must be certification eligible and will have one year to obtain required certification.
ACM, CCM, C-SWCM or ACSW certification preferred
Knowledge, Skills and Abilities
Organizational skills Time management skills Crucial conversation skills Problem solving skills Critical thinking skills Work Shift Variable (United States of America) Location Hillcrest/Simpsonville Medical Campus Facility 1003 Hillcrest Hospital Department 10037517 Hillcrest Hospital Care Management Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health. Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family. Our promise is to: Inspire health. Serve with compassion. Be the difference.
