Care Transition Manager Social Worker LMSW/LCSW Bring your passion to Texas Health so we are Better + Together Work location: Texas Health Cleburne 201 Walls Dr. Cleburne, TX 76033 Work hours: PRN Days - Between 8:00 am - 5p to cover sick/pto time. Occasional weekends required. Department highlights: · Robust Unit Based Council (UBC) and engaged leadership team · The Care Transition team ensures that patients are transitioned to appropriate level of care in a timely and effective manner. Provides education, care and resources to patients across various specialties to identify transition needs and discuss post- acute care options · Manageable Case Load · Team that works together to ensure work life balance for all Here’s What You Need · Master's Degree Social Work Required (Individuals hired as a CTSW prior to May 11, 2017, will be grandfathered to the CTSW position with BSW, at the entity they were employed at on May 11, 2017) · 3 Years’ experience in hospital/medical social work Preferred · 1 Year discharge planning/care management Preferred · LMSW - Licensed Master Social Worker Upon Hire Required Or LCSW - Licensed Clinical Social Worker Upon Hire Required · CPR - Cardiopulmonary Resuscitation Upon Hire Required · ACM - Accredited Case Manager Upon Hire Preferred · CCM - Certified Case Manager Upon Hire Preferred Or Other ANCC Upon Hire Preferred What You Will Do • Working knowledge of medical necessity criteria preferred • Knowledge of Microsoft Outlook and Office (Word, Excel) • Customer service skills • Ability to engage in complex clinical decision-making and discharge planning • Strong oral and written communication skills • Strong commitment to interdisciplinary collaboration • Critical thinking, analysis and conflict resolution skills • Psychosocial and crisis intervention skills • Ability to prioritize and meet deadlines • Identify community resources and service needs and facilitate appropriate referrals as needed. • Responsible for ensuring 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 and collaborates with the interdisciplinary team to identify high risk patients whose THRIL score may not have indicated appropriately. • Promotes discussion and assists in the identification of a primary care physician (PCP) for patients without a PCP • Completes Transition Evaluations on patients within 24 hours of identification and begins discharge planning Additional perks of being a Texas Health Social Worker · Benefits include 401k, discounts in the cafeteria. · A supportive, team environment with outstanding opportunities for growth. · Explore our Texas Health careers site for info like Benefits, Job Listings by Category, recent Awards we’ve won and more. Do you still have questions or concerns? Feel free to email your questions to [email protected]