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Social Worker / Discharge Planning Coordinator - Care Navigation - Part Time - Days

Company: ProMedica
Location: Monroe
Posted on: June 12, 2021

Job Description:

ProMedica is a locally-owned, nonprofit health system providing quality health care services to 27 counties in northwest Ohio and southeast Michigan. We're a network of hospitals, physicians, health care professionals, researchers, and specialty clinics and facilities. We offer a full range of diagnostic, medical, and surgical specialties in areas such as emergency medicine and trauma, heart and vascular, oncology, orthopedics, neurology, women's services, and children's services.

Position Summary:

Responsible for coordinating placement, community agency referral, and social coping aspects for patients in the assigned areas, inclusive of all age groups served. Serve as a referral source and resource to other staff in an effort to promote the delivery of high quality, fiscally responsible continuing care services. Individual provides psychosocial support and guidance to meet the needs of the patient.

Primary Duties:

  • Proactively follows up with inpatient referrals and consults.
  • Conducts face-to-face interviews with patients and family members to develop therapeutic relationships and obtain psychosocial and financial information necessary for the facilitation of appropriate discharge planning.
  • Performs psychosocial assessment on all referrals and mental health or substance abuse assessment as needed and documents within 24 hours of referral.
  • Completes the following psychosocial transition planning services: New facility placements, New dialysis patients, Hospice, Rapes, Teen pregnancy, Homeless, Domestic violence/domestic dispute, Abuse, Counseling, Adult protective/Child protective services, Guardianship, Crisis intervention, Other tasks as appropriate
  • Provides information to patients and families about community resources - including skilled nursing and acute rehabilitation facilities, financial programs, counseling agencies, and other providers of concrete and supportive services - and educate them, as needed, about steps needed in selecting and accessing community resources, documenting patient choice of the final selection.
  • Counsels patients and families, as appropriate, regarding issues related to adjustment to illness, difficulties in accessing community resources, financial difficulties, future long-term care planning, protection issues, advance directives, and other psychosocial problems.
  • Effectively communicates with hospital staff, patients, and families, and outside resources information needed to facilitate timely and appropriate discharges and provide other needed services to families.
  • Refers patients and family members to in-house (financial counselor, chaplain, etc.) and community resources for help with financial programs and other tangible resources, rehabilitation and nursing services, counseling and support services, and other psychosocial needs.
  • Provides assistance to members of the interdisciplinary team regarding community resources and agencies, financial programs, regulatory standards and other psychosocial needs.
  • Documents required and other pertinent information on the patient's medical chart, including psychosocial information and final transition plan, to describe progress on cases, clearly indicating that patient choice was encouraged regarding community resources and what the final choice is.
  • Works collaboratively with patients, families, and health care team members in the coordination and monitoring of activities of all parties to ensure transition plans are implemented in a timely and fiscally responsible manner.
  • Serves as a patient advocate during the course of the patient's hospitalization with a goal of promoting a sense of the continuum of care and a climate of concern for individual patient/family welfare.
  • Establishes and maintains positive working relationships with patients, family members, and members of the health care staff, incorporating positive customer service standards into daily work.
  • Ensures appropriate transportation is arranged for patient discharge.
  • Escalates concerns to leadership, as appropriate.
  • Completes other duties as assigned.

Job Requirements

  • Must be a licensed social worker
  • Previous case management or discharge planning experience preferred.
  • Must have knowledge of federal regulations and community resources.
  • Must be able to function effectively in a critical care environment.
  • Written and verbal skill essential.
  • Must be able to establish priorities and communicate and respond to inquiries.
  • Must be able to stand for long periods of time.
  • Must be able to work rapidly for long periods of time.

ProMedica is a mission-based, not-for-profit integrated healthcare organization headquartered in Toledo, Ohio. For more information, please visit

Qualified applicants will receive consideration for employment without regard to race, color, national origin, ancestry, religion, sex/gender (including pregnancy), sexual orientation, gender identity or gender expression, age, physical or mental disability, military or protected veteran status, citizenship, familial or marital status, genetics, or any other legally protected category. In compliance with the Americans with Disabilities Act Amendment Act (ADAAA), if you have a disability and would like to request an accommodation in order to apply for a job with ProMedica, please contact

Equal Opportunity Employer/Drug-Free Workplace

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Part Time

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Keywords: ProMedica, Detroit , Social Worker / Discharge Planning Coordinator - Care Navigation - Part Time - Days, Other , Monroe, Michigan

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