Social Worker Case Manager Full Time Evenings at AdventHealth

Date Posted: 10/10/2019

Job Snapshot

  • Job Schedule
  • Job Category
  • Date Posted:
  • Job ID:
  • Job Family
    Case Management
  • Travel
    Yes, 25 % of the Time
  • Shift
    2 - Evening
  • Application Zone
    1-Shared Services
  • Organization
    AdventHealth Hendersonville

Job Description


Social Worker Case Manager Full Time Evenings AdventHealth Hendersonville

Location Address: 100 Hospital Drive, Hendersonville, NC  28792


Top Reasons To Work At AdventHealth Hendersonville

Community Involvement

Located in the beautiful mountains of Western North Carolina

Great Benefits

Co-workers that feel like family

Faith Based

Work Hours/Shift:

Full Time Evenings, 40 hours/week


Individuals must possess these knowledge, skills and abilities and be able to explain and to demonstrate that s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities.  Proficiencies include completing comprehensive psychosocial assessments; crisis intervention; cultural awareness; grief counseling; and patient advocacy.


•        Coordinates/facilitates patient care progression throughout the continuum.

•        Secures discharge appointments to promote successful transitions of care.

•        Works collaboratively and maintains active communication with physicians, nursing, EMS, community non-profit, law enforcement and other members of the multi- disciplinary care team to effect timely, appropriate patient management.

•        Addresses/resolves system problems impeding diagnostic or treatment progress.  Proactively identifies and resolves delays and obstacles to discharge.

•        Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate transition to the next appropriate level of care.

•   Utilizes advanced conflict resolution skills as necessary to ensure timely resolution of issues.       

•        Collaborates with medical staff, nursing staff, and ancillary staff to eliminate barriers to efficient delivery of care in the appropriate setting.

•        Applies approved clinical appropriateness criteria (CMS Compliance guidelines) to monitor appropriateness of admissions observations, inpatients, outpatients in a bed and continued stays, and documents findings based on Department standards.

•        Identifies at-risk populations using approved screening tool and follows established reporting procedures.

•        Assessment competency and knowledge application for all ages from newborn to geriatric.

•        Assessment competency for appropriate use of hospital services and care coordination.

•        Excellent oral communication skills.

•        Excellent written communication skills.

•        Excellent computer skills.

•        Ability to work independentlyPRINCIPLE DUTIES AND JOB RESPONSIBILITIES:


•   Demonstrates knowledge and skills necessary to assess the psychological, social, environment and financial impact of illness and hospitalization on the patient/family, identifying age-specific needs adapting interventions accordingly.

•   Communicates with patient/parent/family regarding health issues and/or concerns based on their level of comprehension, understanding and readiness to learn.

•   Demonstrates the knowledge and ability to identify and facilitate access to developmentally appropriate referrals and resources in-order to meet the patient's/family's post-hospital needs.


Completes a comprehensive assessment on patients referred for psychosocial intervention and level of care needs at transition..

•   Completes discharge planning assessment to assess the psychological, social, environmental, and financial-impact of illness and hospitalization on patient and family.

•   Performs ongoing reassessments which accurately reflect patient's physical/functional, emotional, social, spiritual, financial, development, and educational needs.

•   Identifies cultural considerations which may impact the plan of care and educates staff

•   Communicates with physician and interdisciplinary team regarding complex discharge planning or psychosocial issues which impact the plan of care.

•   Shares relevant points from assessment with team during unit interdisciplinary rounds.

Develops, Coordinates, and Implements a Discharge Plan for Patient

•   Based on assessment outcome, recommends a discharge plan to physician, patient, and family.

•   Provides proactive planning and creative solutions to facilitate seamless care, and patient movement to the appropriate post-hospital level of care in a timely manner.

•   Through supportive intervention and education, facilitates patient/family decision-making and actions needed to accomplish a safe and appropriate discharge plan.

•   Discusses insurance benefits for covered services, and preferred providers, with payers; and provides this information to patient/family.

•   Arranges complex discharges to skilled nursing, rehabilitation and assisted living facilities as indicated by particular needs of clinical area assigned.

•   Makes referrals based on psychosocial needs such as mental health services, substance abuse rehabilitation, homeless placement (i.e., shelters), as well as financial (i.e., insurance) and medication assistance.

•   Utilize problem-solving skills to manage difficult cases, including those involving delays (special attention to re-admissions, long length-of-stays, and indigent cases).

Provides psychosocial expertise and services to patients/families, physicians and hospital staff to support the plan of care.

•   Contributes to patient individualized plan of care based on expertise regarding psychosocial, cultural, developmental, and ethical issues.

•   Provides patient/family counseling for psychological adjustment to consequences of illness and/or hospitalization, including facilitating acceptance of the discharge plan and emotional preparation for life changes.

•   Assesses and reports suspected child, elder, and disabled adult abuse or neglect and serves as communication link between patient, family, protective services, law enforcement, and physician to ensure safety of the patient, minimal disruption of patient care, and emotional support.

•   Provides assessment, counseling, and referrals in domestic violence situations. P

•   Provides interventions for end of life decision-making and acts as liaison with the Palliative Care or Hospice team.

•   Offer bereavement support, and appropriate referrals for bereavement services following death events.

•   Provides education for nursing and other staff on psychosocial issues such as emotional impact of various illnesses, domestic violence, advance directives, cultural considerations, development issues, etc.



•   Master degree from a Council on Social Work Education (CSWE) accredited school of social work or

        Master of Mental Health Counseling or

        Master in Health Services.

•   One year post-Master's degree attainment experience in counseling, or health care-related social work preferred.

•   Excellent interpersonal skills, oral and written communication skills required. 

•   PC application familiarity (i.e., electronic medical record documentation, Word Processing, spreadsheet interpretation).

Job Summary:

To assist in meeting the psychosocial needs of patients and families and facilitate discharge; planning and coordination in situations where more complex post-hospital care needs exist; provides counseling to address the impact of illness on the patient/family system; applies knowledge of age/developmental issues to assist in the patient's adjustment and healing.

The Social Worker Case Manager is accountable for the organization, to facilitate the flow of patients to the next site (level) of care including inpatient acute care, community services or transfer to another facility/campus, sequence of services and resources that are necessary and appropriate for the achievement of patient care outcomes within effective time frames on a specific group of patients.  In addition, the Social Worker Case Manager will coordinate the plan of care among all members of the health care team.  The Social Worker Case Manager must have the professional ability to practice under minimal supervision and perform the following seven essential activities of Case Management: Appropriateness of Setting, Assessment, Planning, Implementation, Coordination, Monitoring and Evaluation, with emphasis on avoiding avoidable admissions in the ED setting, facilitate appropriate follow-up for a smooth transition from the ED to community, decreasing length of stay and monitoring cost effective health care across the continuum of care.  The Social Worker Case Manager must continually review the patient to facilitate status, patient needs with the appropriate level and type of medical, psychosocial, or social service as they relate across the continuum of care. 

This facility is an equal opportunity employer and complies with federal, state and local anti-discrimination laws, regulations and ordinances.

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