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  3. Care Transition Social Worker - Full Time Days
TH

Care Transition Social Worker - Full Time Days

Texas Health Resources·Cleburne, Texas

Full Time·On Site·2-5 yrs·Posted 10 hours ago
Practice for this role

About the role

The Care Transition Social Worker ensures patients are transitioned to the appropriate level of care in a timely and effective manner. They collaborate with interdisciplinary teams to manage discharge planning, identify high-risk patients, and facilitate community resource referrals.

Care Transition Manager Social Worker LMSW/LCSW Bring your passion to Texas Health so we are Better + Together Work location: Texas Health Cleburne 201 Walls Dr. Cleburne, TX 76033 Work hours: Full Time Days - Between 8:00 am - 5p Occasional weekends required Department highlights: · Robust Unit Based Council (UBC) and engaged leadership team · The Care Transition team ensures that patients are transitioned to appropriate level of care in a timely and effective manner. Provides education, care and resources to patients across various specialties to identify transition needs and discuss post- acute care options · Manageable Case Load · Team that works together to ensure work life balance for all

  • Here’s What You Need · Master's Degree Social Work Required (Individuals hired as a CTSW prior to May 11, 2017, will be grandfathered to the CTSW position with BSW, at the entity they were employed at on May 11, 2017) · 3 Years’ experience in hospital/medical social work Preferred · 1 Year discharge planning/care management Preferred · LMSW - Licensed Master Social Worker Upon Hire Required Or 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 Or Other ANCC Upon Hire Preferred What You Will Do
  • Working knowledge of medical necessity criteria preferred
  • Knowledge of Microsoft Outlook and Office (Word, Excel)
  • Customer service skills
  • Ability to engage in complex clinical decision-making and discharge planning
  • Strong oral and written communication skills
  • Strong commitment to interdisciplinary collaboration
  • Critical thinking, analysis and conflict resolution skills
  • Psychosocial and crisis intervention skills
  • Ability to prioritize and meet deadlines
  • Identify community resources and service needs and facilitate appropriate referrals as needed.
  • Responsible for ensuring patients are transitioned to appropriate levels of care in a timely and effective manner.
  • Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients and collaborates with the interdisciplinary team to identify high risk patients whose THRIL score may not have indicated appropriately.
  • Promotes discussion and assists in the identification of a primary care physician (PCP) for patients without a PCP
  • Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning Additional perks of being a Texas Health Social Worker · Benefits include 401k, discounts in the cafeteria. · A supportive, team environment with outstanding opportunities for growth. · Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more. Do you still have questions or concerns? Feel free to email your questions to recruitment@texashealth.org.

Requirements

Candidates must hold a Master's degree in Social Work and possess an active LMSW or LCSW license. Preferred qualifications include three years of hospital social work experience and relevant case management certifications.

  • postgraduate degree
  • Microsoft Office
  • Microsoft Outlook
  • Customer service
  • Written communication
  • Critical thinking
  • Conflict resolution
  • Time management
  • Oral communication
  • Discharge planning
  • Crisis intervention
  • Interdisciplinary collaboration
  • Psychosocial assessment
  • Care management
  • Clinical decision-making
  • Medical social work
  • Community resource identification

Benefits

  • 401k
  • Supportive team environment
  • Growth opportunities
  • Cafeteria discounts

Posting details

Employment type
Full Time
Work arrangement
On Site
Experience
2-5 yrs
Location
Cleburne, Texas
Posted
Jul 28, 2026
Application
Employer website
TH

Hiring organization

Texas Health Resources

At Texas Health Resources, our mission is to improve the health of the people in the communities we serve. We are one of the largest faith-based, nonprofit health systems in the United States with a team of more than 28,000 employees of wholly owned/operated facilities and...

IndustryHospitals and Health Care
TypeNonprofit
Size10,001+ employees
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Market context

Texas behavioral health roles need licensed clinicians

Behavioral-health openings in Texas often favor licensed clinicians because employers need candidates who can step into patient-facing care with minimal onboarding. Competition is shaped by the required master’s degree, Texas license, and preferred psychiatric experience, plus CPR and CPI certifications. Review the AI-summarized requirements and benefits on this page to save research time, then confirm your license type and highlight any psychiatric or crisis-care experience in your application.

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