Care Coordinator SW Sr KHC

Job Summary

How would you like to work in a place where your contributions and ideas are valued? A place where you can serve with compassion, pursue excellence and honor every voice? At Wellstar, our mission is simple, yet powerful: to enhance the health and well-being of every person we serve. We are proud to have become a shining example of what's possible when the brightest professionals dedicate themselves to making a difference in the healthcare industry, and in people's lives.

Work Shift: Day (United States of America)

Core Responsibilities and Essential Functions:

• Complex Disposition Planning
• Implements discharge planning and provides resource information in a timely and efficient manner for complex patients.
• Identifies and documents barriers for timely disposition.
• Understands eligibility processes and criteria for both private and public local, state, and federal resources to assist in planning a safe and appropriate transition for discharge.
• Responds to referrals for patient assistance from RN Care Coordinators, physicians and the care team.
• Participates in Interdisciplinary Rounds with the patients care team to confirm estimated date of discharge and make recommendations for best level of care transition at discharge.
• Initiates/facilitates post-acute referrals through departmental processes for timely transition to the next level of care.
• Provides financial needs assessment for patients requiring assistance for follow-up care throughout the continuum.
• Advocates and partners with the patient and family to empower them to make autonomous health care decisions keeping the patient and their wishes at the center of all discharge planning.
• Allows for any cultural or religious beliefs in providing service and continuity of care.
• Assessment
• Based on preliminary screening of patients, initiates assessment of patients psychosocial risk factors and availability of resources to assist upon discharge.
• Partners with the PAS, financial counselor, and/or UM nurse to assess insurance and coverage requirements for all payers to ensure adherence to those requirements.
• Collaborates with the patient and family, along with the physician(s) and other members of the care team to fully establish and support both the patient's care progression and discharge plans.
• Documentation
• Initial psychosocial/functional assessment completed and documented in the medical record.
• Ensure all records are up-to-date and documentation is understandable.
• Ensure timely and accurate documentation of progress notes and interactions with the patient/family.
• Accounts for and indicates all services arranged/delivered in the Electronic Health Record.
• Track avoidable days and report trends that lead to undesired outcomes.
• Precepting/Mentoring
• Assist leadership with precepting new hires when needed.
• Mentor new and less senior employees in addressing challenging situations in assisting patients/families through the continuum of care.
• Serves as a preceptor and/or mentor for student interns.
• Professional Development and Initiative
• Completes all initial and ongoing professional competency assessment, required mandatory education, population specific education.
• Supports departmental-based goals which contribute to the success of the organization.
• Participates in the development of protocols, procedures and performance improvement as indicated to optimize patient outcomes.
• Performs other duties as assigned.
• Complies with all Wellstar Health System policies, standards of work, and code of conduct.

Required Minimum Education:

Master's Degree degree in Social Work from an accredited college or university Required and LMSW in State of GA (can be waived if have LCSW) Required and ACM or CCM Preferred

Required Minimum License(s) and Certification(s):

• Lic Clinical Social Worker GA or Lic Master Social Worker GA
• Basic Life Support or BLS - Instructor
• Certified Case Manager-Preferred or Accredited Case Manager-Preferred

Additional License(s) and Certification(s):

• LMSW in State of GA (can be waived if have LCSW in State of GA) Upon Hire Required
• ACM or CCM Upon Hire Preferred

Required Minimum Experience:

Minimum 2 years experience in healthcare in the acute care setting, related field or skilled care environment or community. Required A background in medical social work in an acute care setting is highly Preferred

Required Minimum Skills:

Excellent written and verbal communication skill. Must possess maturity, self-confidence, objectivity, and positive attitude. Self-directed with the ability to function well under stress, handle change, and function in a fast-paced environment Strong assessment, interview, organizational and problem-solving skills. Knowledge regarding local, state and federal regulations required. Knowledge of community and state-wide resources and programs. Ability to work collaboratively with physicians, members of the care team, and the patient/family to assist through the continuum of care.

Join us and discover the support to do more meaningful workand enjoy a more rewarding life. Connect with the most integrated health system in Georgia, and start a future that gives you more.