Social Work Case Manager - Full Time - On Site at AVH

Company : Allegheny Health Network Job Description : $10,000 sign on bonus available GENERAL OVERVIEW: This job collaborates with the interdisciplinary team of providers, clinicians, health plans, and external partners while advocating for patients and families/caregivers to coordinate care across the continuum. The incumbent is an integral member of the Care Management team that works to improve the quality of care, patient experience, and the health of populations and individuals by focusing on the social determinants of health impacting wellness. ESSENTIAL RESPONSIBILITIES Contributes to and/or completes initial and ongoing comprehensive assessment. Provides interventions and implements recommendations after engaging patients and their caregivers/families. Focuses on the individual's risk related to social determinants of health to assure successful coordination of care across the continuum. (30%) Collaborates to provide the safest transition plan for assigned patients (Inpatient/Observation/ED) to ensure a timely discharge and provide appropriate connection with post-discharge care providers and community-based resources. (25%) Educates patient, family/caregiver and physician regarding most appropriate level of care post discharge and how to access community support. Advocates for the patient, family/caregiver through effectively communicating with interdisciplinary team members, payers and post-acute partners to assure the safest transition. (20%) Serves as a resource to provide counseling and intervention related to treatment decisions and end-of-life issues. Drives collaborative conversations to establish goals of care. Provides crisis interventions in cases involving Child Abuse and Neglect, Domestic Violence, Adult and Older Adult Abuse, Institutional Abuse Sexual Assault, Mental Health Disorders, Substance Use Disorders, and Identification of a Surrogate Decision Maker/Guardianship. (15%) Promotes individual professional growth and development through certification, mentoring/precepting, and/or participation on department/hospital/system committees. (5%) Supports Department based goals that contribute to the success of the organization. (5%) Other duties as assigned. QUALIFICATIONS: Minimum Experience in a hospital or health care setting Preferred None Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law. We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below. For accommodation requests, please contact HR Services Online at California Consumer Privacy Act Employees, Contractors, and Applicants Notice