Social Worker Case Manager - Exeter Hosptial

When you join the growing BILH team, you're not just taking a job, you’re making a difference in people’s lives.

Performs a variety of services with all patient populations including psychosocial needs assessments, patient / family education regarding community, state and federal resources. Provides counseling to patients and families about impact of hospitalization and illness on well being.

Job Description: Per Diem, may include some weekends

Key Responsibilities:

• Assess patients referred for social work case management services through physician and nursing referrals, multidisciplinary rounds, patient or family requests, and community agency referrals.
• Conduct proactive screening of high-risk patients through census reviews and participation in multidisciplinary rounds.
• Perform comprehensive needs assessments, identify patient priorities and preferences, and collaborate with patients, families, interdisciplinary team members, and community resources to develop effective care plans.
• Coordinate and implement care plans using best-practice approaches, ensuring alignment with patient goals and desired outcomes.
• Monitor, evaluate, and revise care plans as needed to support quality, cost-effective care and optimal patient outcomes.
• Serve as a liaison and advocate between patients, families, healthcare providers, community agencies, and insurance payers.
• Advocate for services, resources, and funding necessary to meet patient care needs and achieve established goals.
• Maintain current knowledge of payer requirements and community resources to facilitate appropriate discharge planning and care coordination.
• Provide supportive counseling, crisis intervention, education, and advocacy to patients and their families.
• Collaborate closely with nurse case managers and other members of the healthcare team, particularly in cases involving complex psychosocial, legal, financial, or discharge-planning needs.
• Prepare and maintain accurate, timely, and compliant case documentation in accordance with organizational policies and state and federal regulations.
• Support continuity of care and promote positive patient outcomes through effective communication, care coordination, and resource management.