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AdventHealth

Integrated health system delivering whole-person care

Social Work Care Management

Case Management & AdvocacyConfirmed live in the last 24 hours
Full-timeTavares, FL, USAIn-person

About the Job

Requirements

  • A master's degree is required.
  • At least 2 years of social work experience is required.
  • Excellent interpersonal communication and negotiation skills are required.
  • Critical thinking and problem-solving skills are required.
  • Psychosocial assessment skills are required.
  • Customer service skills are required.
  • Ability to work and communicate with people of all social, economic, and cultural backgrounds, and to be flexible, open-minded, and adaptable to change is required.
  • Effective organizational skills are required.
  • Computer proficiency with Outlook email and electronic medical records is required.
  • Flexibility in a complex and changing healthcare environment is required.
  • Understanding of pre-acute and post-acute venues of care and post-acute community resources is required.
  • Current working knowledge of services available in the local community, particularly services available to patients with limited or no payment resources, is required.
  • Strong interview, assessment, and organizational skills are required.
  • Leadership skills are required.
  • Data analysis skills are required.

Responsibilities

  • Provide grief counseling, disease adjustment support, crisis intervention, goals-of-care planning support, and de-escalation services for patients as appropriate.
  • Assess patients and families holistically for discharge-planning needs in inpatient, observation, and/or emergency departments, including prior functioning, support systems, financial circumstances, and psychosocial needs, in a timely manner to avoid discharge-planning delays.
  • Review the medical record, including medications, history and physical, laboratory results, and progress notes, and incorporate clinical, social, and financial factors into the transition-of-care plan.
  • Develop discharge plans with appropriate contingency plans throughout the hospital stay to support timely care coordination and progression of care, arranging post-acute care services and facilities as well as community care for social needs.
  • Use technology and follow standard work and best practices to communicate with post-acute care services and facilities, ensuring patient-care information is communicated for continuity of care, medical records are complete, and discharge reconciliation is accurate.
  • Participate in multidisciplinary rounds to review changes in patient status, progression and level of care, and discharge plans for assigned patients; identify resources necessary at discharge, ensure a timely transition, and escalate care delays to leadership as appropriate.
  • Communicate with and educate patients and families about the emotional, social, and financial impacts of illness; mobilize family and community resources to meet identified needs while advocating for patient and family empowerment in making healthcare decisions and accessing needed services.
  • Organize and facilitate patient and family care conferences with the multidisciplinary team.
  • Document discharge-planning evaluations, ongoing assessments, discharge plans, multidisciplinary rounds, barriers to progression of care, avoidable days, and patient and family needs according to standard work.
  • Provide patient and family advocacy and support patient choice and rights during hospitalization.
  • Communicate patients’ post-acute care authorization needs to payors as needed.
  • Assess readmitted patients to understand the reasons for readmission as perceived by the patient and family.
  • Perform other duties as assigned.

Desired Qualifications

  • At least 2 years of care management experience is preferred.
  • Current working knowledge of discharge planning, utilization management, care management, performance improvement, and managed-care reimbursement is preferred.
  • Knowledge of state and federal guidelines pertinent to care management is preferred.
  • Ability to identify appropriate community resources and collaborate with patients, families, the multidisciplinary team, and community agencies to achieve desired patient outcomes is preferred.
  • Accredited Case Manager (ACM) certification is preferred.
  • Certified Case Manager (CCM) certification is preferred.

About the Company

AdventHealth

Integrated health system delivering whole-person care

AdventHealth operates a nationwide network that provides whole-person health care across hospitals, physician practices, ambulatory surgery centers, outpatient clinics, home health, hospice, and digital tools. It coordinates care through an integrated system where care teams work across inpatient, outpatient, and at-home settings, supported by the AdventHealth app for scheduling, telehealth, and records. It differentiates itself with a mission-driven focus rooted in Christian heritage and a large, connected network designed to cover the full patient journey from hospital to home. Its goal is to extend the healing ministry of Christ by improving the health and prosperity of the communities it serves, offering accessible, coordinated care that addresses physical, mental, and spiritual well-being.

Company size
10,001+
Company stage
Grant
Total funding
$250K
Headquarters
Florida, United States
Founded
1973

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