Social Worker / Discharge Planning Coordinator - Care Navigation - Part Time - Days
Posted on: June 12, 2021
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.
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.
- Proactively follows up with inpatient referrals and
- 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
- 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
- Effectively communicates with hospital staff, patients, and
families, and outside resources information needed to facilitate
timely and appropriate discharges and provide other needed services
- 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
- 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
- Establishes and maintains positive working relationships with
patients, family members, and members of the health care staff,
incorporating positive customer service standards into daily
- Ensures appropriate transportation is arranged for patient
- Escalates concerns to leadership, as appropriate.
- Completes other duties as assigned.
- Must be a licensed social worker
- Previous case management or discharge planning experience
- Must have knowledge of federal regulations and community
- Must be able to function effectively in a critical care
- 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 www.promedica.org/about-promedica
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
Equal Opportunity Employer/Drug-Free Workplace
Employee Exemption Type
Budgeted Hours / Pay Period
Additional Schedule Details
Keywords: ProMedica, Detroit , Social Worker / Discharge Planning Coordinator - Care Navigation - Part Time - Days, Other , Monroe, Michigan
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