Care Transition Manager, SW; PRN

Care Transition Manager SW (Social Worker) – Case Management

Bring your passion to Texas Health so we are Better + Together!

Work location: Texas Health Plano, 6200 West Parker Road, Plano TX 75093

Work hours: PRN - Flexible, M-F and weekends. 8a-5p. Two holidays per year required

Care Management Highlights:

· Flexible daytime hours

· Opportunity to work with a diverse group of highly educated professionals

· Care coordination with focus on timely discharges

· Ability to pick your own schedule

· Multidisciplinary team focus

· Team oriented with focus on providing compassionate patient centered care

· Evidence based practice

Care Transition Manager SW (Social Worker) – Case Management

Bring your passion to Texas Health so we are Better + Together!

Work location: Texas Health Plano, 6200 West Parker Road, Plano TX 75093

Work hours: PRN - Flexible, M-F and weekends. 8a-5p. Two holidays per year required

Care Management Highlights:

· Flexible daytime hours

· Opportunity to work with a diverse group of highly educated professionals

· Care coordination with focus on timely discharges

· Ability to pick your own schedule

· Multidisciplinary team focus

· Team oriented with focus on providing compassionate patient centered care

· Evidence based practice

Here’s What You Need

· Master’s degree in social work required

· Three years of experience in hospital/medical social work preferred

· One year of experience of discharge planning/care management

· Hospital Case management preferred

· LMSW – Licensed Master Social Worker upon hire required or LCSW – Licensed Clinical Social Worker upon hire required and CPR -Cardiopulmonary Resuscitation upon hire required and ACM – Accredited Case Manager upon hire preferred or CCM – Certified Case Manager upon hire preferred or Other – ANCC upon hire preferred

What You Will Do

· Ensure patients are transitioned to appropriate levels of care in a timely and effective manner:

· Reviews the Texas Health Readmission Indicator List (THRIL) scores daily for all assigned patients

· Identify high risk patients whose THRIL score

· Promotes discussion and assists in the identification of a primary care physician (PCP) for patients

· Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning

· Interviews and assesses patients and caregivers as part of the transition evaluation

· Identifies transition needs and discusses funding of post-transition care with patients and caregivers

Additional perks of being a Texas Health Social Worker