Case Manager-Social Worker

At ScionHealth , we empower our caregivers to do what they do best. We value every voice by caring deeply for every patient and each other. We show courage by running toward the challenge and we lean into new ideas by embracing curiosity and question asking. Together, we create our culture by living our values in our day-to-day interactions with our patients and teammates.

Job Summary

The Case Manager-Social Worker coordinates and facilitates the care of patients throughout the continuum of care in an acute-care hospital setting. The role involves effective collaboration and communication with Interdisciplinary Care Transitions (ICT) team members, physicians, patients, and families to ensure optimum utilization of resources, service delivery, and compliance with external review agencies. The Case Manager-Social Worker conducts comprehensive assessments, develops care plans, implements and evaluates interventions to enhance patient management, promote continuity of care, and support cost-effective outcomes.

Essential Functions

• Coordinate clinical and psycho-social activities with the Interdisciplinary Team to provide comprehensive care coordination and discharge planning.
• Conduct comprehensive biopsychosocial assessments to provide timely and safe discharge planning, referring cases to Social Workers as applicable.
• Monitor patient care to ensure effective coordination and efficient care facilitation from admission through discharge.
• Perform medical necessity reviews and assess the appropriateness of clinical resource utilization.
• Develop and implement discharge plans that address both immediate and post-discharge needs, coordinating with community resources as needed.
• Serve as a patient advocate, promoting informed decision-making and maximizing patient and family understanding of care plans.
• Participate in interdisciplinary patient care rounds and conferences to review treatment goals and optimize resource utilization.
• Maintain accurate documentation of patient care, discharge planning activities, and third-party payor reviews according to regulatory requirements.
• Stay informed about government and non-government payor practices, regulations, standards, and reimbursement policies.

Knowledge/Skills/Abilities/Expectations

• Knowledge of government and non-government payor practices, regulations, standards, and reimbursement.
• Knowledge of Medicare benefits and insurance processes and contracts.
• Excellent interpersonal, verbal, and written communication skills to effectively interact with patients, families, and healthcare providers.
• Strong organizational and critical thinking skills to manage multiple patient cases simultaneously.
• Basic computer skills, including proficiency in Microsoft Office Suite and electronic medical records systems.
• Ability to work collaboratively within a multidisciplinary team to achieve optimal patient outcomes.
• Must maintain regular attendance and adhere to hospital policies and procedures.

Education

• Graduate of an accredited program in Social Work (Master’s degree preferred; Bachelor’s degree required).
• Licensure as required by state regulations as a Licensed Clinical Social Worker (LCSW) or Licensed Social Worker (LSW).

Licenses/Certifications

• Healthcare professional licensure as LCSW or LSW as required by state regulations.
• Certification in Case Management preferred.

Experience

• Minimum of one year of experience in a healthcare setting, with experience in case management, utilization review, or discharge planning preferred.
• Experience in acute care, medical/surgical, or ICU/CCU settings is a plus.