Social Worker LMSW

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Location:
Fort Worth, TX US
Job ID:
101568
Area of Interest:
Social Services
Job Type:
Full Time
Facility:
Texas Health Fort Worth


Qualifications/Duties:
Works Schedule:
3 days - 12 hour shifts a week from 11:30am to Midnight

Education:
Required minimum education: Master's of Social
Work required or Licensed Clinical Social Worker

Experience:
Required minimum experience:
2 years of healthcare related Social Work

3 years in hospital/medical social work (preferred)

Recent experience in acute care hospital discharge planning/care management (preferred)

License / Certification:
Required license/certification: LMSW - Licensed Master Social Worker upon hire required.
LCSW - Licensed Clinical Social Worker upon hire preferred.
BCLS - Basic Cardiac Life Support by June 30, 2018.
CPR - Cardiopulmonary Resuscitation (Completed by June 30, 2018 or within 90 days of hire)
required.
ACM - (Accredited Case Manager) upon hire preferred.
CCM - (Certified Case Manager) upon hire preferred.
Required skills (if applicable): 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
Strong oral and written communication skills
Strong commitment to interdisciplinary collaboration and communication
Strong skills in the preparation of clinically pertinent medical record documentation
Critical thinking and analysis skills and conflict resolution skills
Psychosocial and crisis intervention skills
Position requires flexible scheduling, including weekend and evening shift work as necessary
Ability to prioritize and meet deadlines.
Preferred experience with electronic health record and automated case management systems.
Individual must be self-directed and goal/outcomes/measurement driven
Reviews Readmission Risk Indicator (THRIL) scores daily for all assigned patients.
Collaborates with interdisciplinary team to identify high risk patients whose RRI score may not have indicated appropriately.
Ensures all assigned patients have an identified Primary Care Physician (PCP). If PCP not identified, exhaust all efforts in an attempt to assign.
Completes Transition Evaluation on all identified patients within 24 hours of referral; documents appropriately.
Interviews/Assesses patients / caregivers as part of transition evaluation and as needed.
Identifies transition needs (including medications), develops transition plan within 24 hours of referral, and discusses funding of post transition care with patients /
caregivers; documents appropriately.
Validates transition plan with Interdisciplinary Team (Physician, Clinical Nurse Leader, Nursing, etc.).
Updates Estimated Transition Date (ETD) as needed.
Educates interdisciplinary team and patients / caregivers regarding available post acute care services and needs.
Communicates transition plan and post acute management plan with patients / caregivers and post acute care stakeholders.
Executes and updates transition plan and post acute management plan as needed.
Facilitates care conferences for complex transitions and/or placement.
Identifies community resources / service needs; facilitates appropriate referrals as needed (acute and non-acute).
Actively communicates with all appropriate post acute care providers throughout patient stay. Communicates final transition plan 24 - 48 hours prior to transition.
Serves as a point of contact for all identified stakeholders.
Assigns patients to appropriate transition program(s) (i.e. NTSP, THPG or based on payor preferences) and provides support as needed

Serves as a content expert regarding payor information. Educates interdisciplinary team and patients / caregivers regarding payor requirements and / or barriers.
Facilitates care conferences for complex transitions and/or placement.
Identifies community resources / service needs; facilitates appropriate referrals as needed (acute and non-acute).
Communicates with payors as needed.
Monitors follow up activities for all appropriate patients post hospitalization and supports patient transition plan adherence.
Escalates issues to appropriate level of CTM leadership and coordinates mitigation activities as needed.
Actively communicates with all appropriate post acute care providers throughout patient stay.
Communicates final transition plan 24-48 hours prior to transition. Serves as a point of contact for all identified stakeholders.
Ensures scheduling of follow-up
PCP appointment (for patients not served by CNL/ PCF).
Schedules clinic follow up appointments in cases in which a PCP is unable to be identified /assigned (for patients not served by CNL/PCF).

Ensures transition plan and post acute management plan consistency across care settings.
Complies with all documentation requirements. Documents all activities in electronic health record.
Adheres to compliance requirements: Code 44 intervention, HINN letters, Second IMM, Observation letter, etc.
Has working knowledge of Advanced Directives, Living Will, Medical Power of Attorney, Out-of-Hospital Do Not Resuscitate Order and Advanced Illness
Participates in Joint Commission readiness activities
Serves as a content expert on the following:
· Psychosocial issues related to hospitalization and transition planning
· Child and Adult Protective Care Services cases (neglect, abuse, etc.); as appropriate.
· Adoptions
· Complex psychiatric referrals
· Applications for community resource needs.
· Guardianship processes
· Mental Health Treatment Declaration – Order of Protective Custody
· Mental health court filings
· Indigent programs as appropriate


Entity Information:
Texas Health Harris Methodist Hospital Fort Worth is a 726-bed, Magnet-designated regional referral center that has served the residents of Tarrant County and surroundings communities since 1930. Hospital services include cardiovascular care, high-risk obstetrics, gynecology, orthopedics and sports medicine, neonatal intensive care, and trauma/emergency medicine. In early 2014, Texas Health Fort Worth will be opening a new 75,000 square foot Emergency Services Center, one of the largest in the region. Texas Health Fort Worth has more than 4,000 employees, 200 volunteers and nearly 1,000 physicians on its medical staff.  Texas Health Fort Worth recently received national recognition for its oncology program and was named “Best Place to Have a Baby” in Tarrant County. The hospital is also a designated Cycle III Chest Pain Center by the Society of Chest Pain Centers We invite you to join us in furthering your career and our accomplishments and philosophy of excellence.
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