SOCIAL WORKER (BA/BSW) PRN
Universal Health Services, Madera, CA, United States
Responsibilities
POSITION SUMMARY
The Social Worker/Case Manager is responsible for managing the assessments and discharge planning activities offered to the patient, which may include assessing patients' needs and compiling a treatment plan within a multidisciplinary team; planning and/or providing care, treatment, and services; collaboration and exchanging of information with the treatment team, external providers, collateral contacts, and/or managed care organizations; and implementation of the discharge planning process including completion of a thorough risk assessment and arranging for follow-up care and resources. The Social Worker/Case Manager will work closely with a Master's-level clinician to provide oversight on assessments and clinical consultation as needed.
QUALIFICATIONS
Education:
Bachelor\'s Degree from an accredited college or university in social work, counseling psychology, mental health or a related field. Enrollment in a Master\'s Degree program in Social Work or Counseling Psychology is preferred.
Experience:
One (1) year direct clinical experience in a psychiatric or mental health setting preferred. Experience in patient assessment, risk and safety assessments, treatment planning, community resources, family systems and communication, psychiatric diagnoses and effective treatments, and coordination with external review organizations preferred.
Additional Requirements:
CPR certification and successful completion of Crisis Prevention Intervention (CPI) training. CPI Training may be obtained during new hire orientation.
PRIMARY RESPONSIBILITIES
Assessments
Complete thorough assessments and documentation within the allotted timeframes. Include patients\' behavior, criteria for hospitalization, and risk assessment in documentation.
Use the hospital criteria for continued evaluation for hospitalization and make appropriate recommendations for level of care upon discharge under the supervision of a Master\'s level clinician.
Complete initial discharge planning and risk assessments under the supervision of a Master\'s level clinician.
Integrate assessment information with the attending physician\'s initial treatment plan and compile a Master Treatment Plan with individualized, measurable, and observable problems, interventions, and short-term goals. Update Master Treatment Plan integrating the patient\'s progress, obtained collateral information, and identified resources.
Assess and document patient\'s ongoing progress including progress towards treatment goals and make changes to the identified plan for discharge/safety as appropriate.
Complete a Chemical Dependency Assessment as needed under the supervision of a Master\'s level clinician.
Case Management
Engage, collaborate, and problem-solve with patients, families, treatment team members and community providers regarding patient status and progress towards discharge.
Ensure/assist that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient\'s status.
Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer.
Maintain necessary documentation of all services and the quality of care.
Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body regulations.
Maintain knowledge of a variety of resources to assist in patient care.
Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care.
Follow through on case management tasks such as discharge planning, documentation, and auditing chart compliance.
Ensure that patient\'s rights are upheld.
Advocate for the lowest level of care consistent with patient needs.
Function as a resource for patient/families/significant others.
Coordinate high risk cases requiring reporting and coordination/communication with other involved agencies.
Facilitate family meetings with patients, support systems, and service providers to enable appropriate discharge with safety and crisis plans in place.
Use current systems and materials to provide \"hand off\" communication.
Discharge Planning
Coordinate discharge plans with the patient/family/significant other that were identified by the treatment team.
Provide, monitor and document discharge planning activities including identification of discharge planning needs, involvement of patient, family and significant others as appropriate, completing referrals for aftercare follow-up, coordination of referrals to other agencies including transmission of necessary information.
Identify and provide appropriate resources to assist with potential risk factors and the patient\'s identified needs.
Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans.
Treatment Planning
Provide support and assistance to the patient and the patient\'s support system.
Formulate an initial discharge plan from information gathered during the assessment process.
Planning/assist in an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case.
Communicate with attending practitioner and treatment coordinator, and other providers of service, to assure continuity of care and expedite the flow of services and transition between levels of care.
Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days/services.
Knowledge of and Adherence to Standards for the Care of Specific Developmental Stages
Specific Standards for the Care of Adolescent Patients Ages 13 through 18
Maintain knowledge of the Adolescent Program rules, protocols and handbooks guidelines.
Assess patients for behaviors consistent with the developmental stages and makes note of any deviations in behavior.
Recognize acting out behavior of adolescent specific age group and set appropriate limits in clear, concise, behavioral and non-judgmental terms based on the age of the patient.
Demonstrate an awareness of learning disabilities and translates treatment/program expectations to the learning disabled adolescent.
Maintain knowledge of the different systems of care and resources available through those systems of care including: Child Protective Services, Juvenile Justice Dept., Adoption Services, Foster Care services, School Services, and EPSDT.
Relate to adolescent patients in an age appropriate manner.
Act as a resource to other staff in regard to the Adolescent Patient Programs.
Facilitate family meetings with adolescents, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Specific Standards for the Care of Adult Patients Ages 19 through 64
Gather information from the patient, family, outpatient provider, and interdisciplinary team and use judgments based on knowledge of adult behaviors in treatment planning and interventions.
Recognize behaviors and set appropriate limits in clear, concise, behaviors and non-judgmental terms.
Maintain current knowledge of the Adult Program rules, protocols and handbook guidelines.
Maintain knowledge of the different systems of care and resources available through those systems of care including: County funded services, Probation and/or Parole, Conserved patients, privately insured services, services for undomiciled/ at risk populations.
Facilitate meetings with patients, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Utilize theoretical concepts to guide the effective practice of adult care within Specific Standards of care for this age group.
Specific Standards for the Care of Geriatric Patients Ages 65 and older
Maintain knowledge of the developmental tasks and sociological theories of aging.
Utilize theoretical concepts to guide the effective practice of gerontological health care and behavioral care
Gather the appropriate information from the patient, family and interdisciplinary team and use therapeutic judgments based on knowledge of gerontological health/behavioral care practices to develop a comprehensive plan of care.
Utilize interventions based on gerontological theory to restore patient\'s functional capabilities and to prevent complications and excess disability.
Maintain knowledge of the different systems of care and resources available through those systems of care including: County funded services, Probation and/or Parole, Conserved patients, privately insured services, services for undomiciled/at risk populations, and geriatric services.
Facilitate meetings with patients, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Specific Standards for the Care of Chemically Dependent Patients
Assesses patient needs as related to chemical dependency and document the plan of care from the admission through discharge.
Collaborate with other chemical dependency staff professionals in planning for discharge and follow-up care.
Maintain knowledge of the different systems of care and resources available through those systems of care including: Sober living environments, rehabilitation centers, county funded services, Probation and/or Parole services, privately insured services, and services for undomiciled/at risk populations.
Maintain an awareness of how personal issues relating the co-dependency can impact work performance/relationships.
Recognize and establish limits on medication-seeking behaviors.
Specific Standards of the Care of Culturally/Spiritually Diverse Patients
Recognize that everyone is uniquely multicultural and show awareness of differences in communication styles and cultural/spiritual values and work ethics.
Demonstrate awareness of one\'s own values, beliefs, stereotypes and bias and how they dictate attitudes and behavior.
Demonstrate an understanding of how cultural rules of behavior impacts how we perceive others and how they perceive us; be willing to modify behavior accordingly.
Rel ationships and Performance
Functions effectively as a member of the team, using tact, sensitivity, sound judgment and a professional attitude when relating to patients, families, visitors, and co-workers.
Addresses patients, visitors, physicians, and co-workers in a pleasant and respectful manner and maintains favorable working relationships.
Responds to patients with empathy and positive interpersonal skills.
Demonstrates flexibility and assumes added tasks when department needs change.
Is receptive to feedback and acts on feedback given.
Discharge Planning and Aftercare
Coordinate discharge plans with the patient/family/significant other that were identified by the treatment team.
Provide, monitor and document discharge planning activities including identification of discharge planning needs, involvement of patient, family and significant others as appropriate, completing referrals for aftercare follow-up, coordination of referrals to other agencies including transmission of necessary information.
Knowledge, Skills, and Abilities
Knowledge of case management techniques; knowledge of patient assessment, family motivating treatment planning techniques; knowledge of external review organizations; knowledge of patient rights, advanced directives, adult and child abuse laws, and emergency detention; knowledge of complex patient care planning; knowledge and utilization of crisis intervention techniques; knowledge of payer resources and financial planning. Excellent leadership, customer relations, organizational and interpersonal communication skills. Ability to communicate effectively both verbally and in writing; ability to handle conflicting situations; focus on details; assess various situations; operate in unstructured environments; tolerate ambiguity and change; work at a rapid pace; adhere to safety policies; maintain confidentiality; work as a team; demonstrate tact, resourcefulness, patience and dedication; accept direction and adapt to patient age groups. Physical, Mental, and Special Demands and Machines, Tools, Equipment sections follow in similar style, converted to paragraphs or lists where appropriate.
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POSITION SUMMARY
The Social Worker/Case Manager is responsible for managing the assessments and discharge planning activities offered to the patient, which may include assessing patients' needs and compiling a treatment plan within a multidisciplinary team; planning and/or providing care, treatment, and services; collaboration and exchanging of information with the treatment team, external providers, collateral contacts, and/or managed care organizations; and implementation of the discharge planning process including completion of a thorough risk assessment and arranging for follow-up care and resources. The Social Worker/Case Manager will work closely with a Master's-level clinician to provide oversight on assessments and clinical consultation as needed.
QUALIFICATIONS
Education:
Bachelor\'s Degree from an accredited college or university in social work, counseling psychology, mental health or a related field. Enrollment in a Master\'s Degree program in Social Work or Counseling Psychology is preferred.
Experience:
One (1) year direct clinical experience in a psychiatric or mental health setting preferred. Experience in patient assessment, risk and safety assessments, treatment planning, community resources, family systems and communication, psychiatric diagnoses and effective treatments, and coordination with external review organizations preferred.
Additional Requirements:
CPR certification and successful completion of Crisis Prevention Intervention (CPI) training. CPI Training may be obtained during new hire orientation.
PRIMARY RESPONSIBILITIES
Assessments
Complete thorough assessments and documentation within the allotted timeframes. Include patients\' behavior, criteria for hospitalization, and risk assessment in documentation.
Use the hospital criteria for continued evaluation for hospitalization and make appropriate recommendations for level of care upon discharge under the supervision of a Master\'s level clinician.
Complete initial discharge planning and risk assessments under the supervision of a Master\'s level clinician.
Integrate assessment information with the attending physician\'s initial treatment plan and compile a Master Treatment Plan with individualized, measurable, and observable problems, interventions, and short-term goals. Update Master Treatment Plan integrating the patient\'s progress, obtained collateral information, and identified resources.
Assess and document patient\'s ongoing progress including progress towards treatment goals and make changes to the identified plan for discharge/safety as appropriate.
Complete a Chemical Dependency Assessment as needed under the supervision of a Master\'s level clinician.
Case Management
Engage, collaborate, and problem-solve with patients, families, treatment team members and community providers regarding patient status and progress towards discharge.
Ensure/assist that the patient attends the appropriate level of care or program as indicated on the treatment plan or as needed when there are changes in the patient\'s status.
Interface with the staff of the appropriate level of care to facilitate a smooth transition at the time of transfer.
Maintain necessary documentation of all services and the quality of care.
Communicate and enforce the documentation requirements with all levels of staff to meet accreditation and certification body regulations.
Maintain knowledge of a variety of resources to assist in patient care.
Promote an effective use of resources for patients, customers and the facility with sensitivity to the cost of health care.
Follow through on case management tasks such as discharge planning, documentation, and auditing chart compliance.
Ensure that patient\'s rights are upheld.
Advocate for the lowest level of care consistent with patient needs.
Function as a resource for patient/families/significant others.
Coordinate high risk cases requiring reporting and coordination/communication with other involved agencies.
Facilitate family meetings with patients, support systems, and service providers to enable appropriate discharge with safety and crisis plans in place.
Use current systems and materials to provide \"hand off\" communication.
Discharge Planning
Coordinate discharge plans with the patient/family/significant other that were identified by the treatment team.
Provide, monitor and document discharge planning activities including identification of discharge planning needs, involvement of patient, family and significant others as appropriate, completing referrals for aftercare follow-up, coordination of referrals to other agencies including transmission of necessary information.
Identify and provide appropriate resources to assist with potential risk factors and the patient\'s identified needs.
Organize the use of resources to keep the patient as close to home as possible, provide liaison to aftercare providers and follow up after discharge to ensure efficacy of the discharge plans.
Treatment Planning
Provide support and assistance to the patient and the patient\'s support system.
Formulate an initial discharge plan from information gathered during the assessment process.
Planning/assist in an episode of care to identify services that will be provided if the patient is moved to a greater or less intensive level of care depending on the needs of the case.
Communicate with attending practitioner and treatment coordinator, and other providers of service, to assure continuity of care and expedite the flow of services and transition between levels of care.
Provide feedback to the attending practitioner and treatment team members concerning continuing certification of days/services.
Knowledge of and Adherence to Standards for the Care of Specific Developmental Stages
Specific Standards for the Care of Adolescent Patients Ages 13 through 18
Maintain knowledge of the Adolescent Program rules, protocols and handbooks guidelines.
Assess patients for behaviors consistent with the developmental stages and makes note of any deviations in behavior.
Recognize acting out behavior of adolescent specific age group and set appropriate limits in clear, concise, behavioral and non-judgmental terms based on the age of the patient.
Demonstrate an awareness of learning disabilities and translates treatment/program expectations to the learning disabled adolescent.
Maintain knowledge of the different systems of care and resources available through those systems of care including: Child Protective Services, Juvenile Justice Dept., Adoption Services, Foster Care services, School Services, and EPSDT.
Relate to adolescent patients in an age appropriate manner.
Act as a resource to other staff in regard to the Adolescent Patient Programs.
Facilitate family meetings with adolescents, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Specific Standards for the Care of Adult Patients Ages 19 through 64
Gather information from the patient, family, outpatient provider, and interdisciplinary team and use judgments based on knowledge of adult behaviors in treatment planning and interventions.
Recognize behaviors and set appropriate limits in clear, concise, behaviors and non-judgmental terms.
Maintain current knowledge of the Adult Program rules, protocols and handbook guidelines.
Maintain knowledge of the different systems of care and resources available through those systems of care including: County funded services, Probation and/or Parole, Conserved patients, privately insured services, services for undomiciled/ at risk populations.
Facilitate meetings with patients, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Utilize theoretical concepts to guide the effective practice of adult care within Specific Standards of care for this age group.
Specific Standards for the Care of Geriatric Patients Ages 65 and older
Maintain knowledge of the developmental tasks and sociological theories of aging.
Utilize theoretical concepts to guide the effective practice of gerontological health care and behavioral care
Gather the appropriate information from the patient, family and interdisciplinary team and use therapeutic judgments based on knowledge of gerontological health/behavioral care practices to develop a comprehensive plan of care.
Utilize interventions based on gerontological theory to restore patient\'s functional capabilities and to prevent complications and excess disability.
Maintain knowledge of the different systems of care and resources available through those systems of care including: County funded services, Probation and/or Parole, Conserved patients, privately insured services, services for undomiciled/at risk populations, and geriatric services.
Facilitate meetings with patients, caregivers, and service providers to enable appropriate discharge with safety and crisis plans in place.
Specific Standards for the Care of Chemically Dependent Patients
Assesses patient needs as related to chemical dependency and document the plan of care from the admission through discharge.
Collaborate with other chemical dependency staff professionals in planning for discharge and follow-up care.
Maintain knowledge of the different systems of care and resources available through those systems of care including: Sober living environments, rehabilitation centers, county funded services, Probation and/or Parole services, privately insured services, and services for undomiciled/at risk populations.
Maintain an awareness of how personal issues relating the co-dependency can impact work performance/relationships.
Recognize and establish limits on medication-seeking behaviors.
Specific Standards of the Care of Culturally/Spiritually Diverse Patients
Recognize that everyone is uniquely multicultural and show awareness of differences in communication styles and cultural/spiritual values and work ethics.
Demonstrate awareness of one\'s own values, beliefs, stereotypes and bias and how they dictate attitudes and behavior.
Demonstrate an understanding of how cultural rules of behavior impacts how we perceive others and how they perceive us; be willing to modify behavior accordingly.
Rel ationships and Performance
Functions effectively as a member of the team, using tact, sensitivity, sound judgment and a professional attitude when relating to patients, families, visitors, and co-workers.
Addresses patients, visitors, physicians, and co-workers in a pleasant and respectful manner and maintains favorable working relationships.
Responds to patients with empathy and positive interpersonal skills.
Demonstrates flexibility and assumes added tasks when department needs change.
Is receptive to feedback and acts on feedback given.
Discharge Planning and Aftercare
Coordinate discharge plans with the patient/family/significant other that were identified by the treatment team.
Provide, monitor and document discharge planning activities including identification of discharge planning needs, involvement of patient, family and significant others as appropriate, completing referrals for aftercare follow-up, coordination of referrals to other agencies including transmission of necessary information.
Knowledge, Skills, and Abilities
Knowledge of case management techniques; knowledge of patient assessment, family motivating treatment planning techniques; knowledge of external review organizations; knowledge of patient rights, advanced directives, adult and child abuse laws, and emergency detention; knowledge of complex patient care planning; knowledge and utilization of crisis intervention techniques; knowledge of payer resources and financial planning. Excellent leadership, customer relations, organizational and interpersonal communication skills. Ability to communicate effectively both verbally and in writing; ability to handle conflicting situations; focus on details; assess various situations; operate in unstructured environments; tolerate ambiguity and change; work at a rapid pace; adhere to safety policies; maintain confidentiality; work as a team; demonstrate tact, resourcefulness, patience and dedication; accept direction and adapt to patient age groups. Physical, Mental, and Special Demands and Machines, Tools, Equipment sections follow in similar style, converted to paragraphs or lists where appropriate.
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