Job Description

Position Summary

The SW Care Manager performs the initial comprehensive assessment on admission in accordance with the Care Management Department policy, screening all patients by utilizing established tools for high risk indicators to ensure high risk patient populations receive the appropriate supportive services for discharge to prevent readmission and assess all populations for potential discharge planning needs. Provides ongoing reassessment of needs throughout the hospital course.

  Essential Functions and Responsibilities Includes the Following:

1. Understands and adheres to the WPH Performance Standards, Policies and Behaviors.
2. Completes a comprehensive initial assessment.
3. Performs all activities for multidisciplinary care coordination at the intra-hospital level of care and inter-hospital level of care.
4. Performs all transitional planning activities including but not limited to:
   • Patient/caregiver education
   • Arrangement of all aftercare
   • Commercial payer involvement
   • High utilizer patient root cause
5. Communicates and collaborates all relevant patient information to appropriate health team members.
6. Ensures department goals of LOS reduction, readmission prevention, denial reduction, and satisfaction improvement are realized.
7. Documents per department requirements.
8. Participates in Performance Improvement activities as needed.
9. Performs all other duties as assigned.

Education & Experience Requirements

• • Master of Social Work Degree from a School of Social Work accredited by the Council of Social Work Education.
  • Licensed Social Worker (LMSW/LCSW) approved by the State Education Department of the University of the State of New York.
  • Two years experience in an acute care hospital setting or related setting preferred.
  • NYS SCREEN Certification (obtained within initial 3 months of employment)

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