Social Worker/Case Manager, Frazier Rehab

Overview

The Case Manager provides comprehensive assessments of the patient (adult and/or pediatric), family and support system serving as the primary liaison between the patient / family and the treatment team. The Case Manager ensures that the patient’s individualized treatment plan is carried out in a focused, cost effective, goal directed manner. As a member of the interdisciplinary team the case manager will also facilitate the development, coordination and implementation of the discharge plan as well as any other outside arrangements to ensure continuity of care. The case manager also serves as the primary liaison facilitating communication with insurance companies, referral sources and community resources as appropriate. It is the Case Manager’s responsibility to ensure that patients in any phase of the program (acute, outpatient, community re-entry) proceed through rehabilitation according to established program guidelines and protocols.

Responsibilities

1. Assists in delivering high quality health care services in a professional, compassionate, and courteous manner while respecting the dignity and individuality of each person who comes in contact with the organization by following the Standards of Excellence, the Standards of Behavior, and the Standards of Professional Appearance and Conduct. (Mandatory for all employees)1.1 Maintains patient privacy and confidentiality at all times according to established procedures.1.2 Follows the Standards of Professional Appearance and Conduct and the departmental dress code.1.3 Communicates effectively and courteously, answering assigned telephone lines within three rings, identifying self at all times.1.4 Assists visitors and patients in giving directions and information.1.5 Communicates effectively and courteously with all visitors, physicians, patients, and employees.1.6 Introduces self and position to patients, families, and visitors at all times.1.7 Assesses environment for safety hazards which could harm patients, visitors, or other hospital employees, and reports hazards to appropriate supervisors.1.8 Collaborates with other departments and outside agencies to meet the identified needs of the patients and the organization.

2. Knowledge and performance of Code of Conduct Standards is evident in performing daily activities. (Mandatory for all employees)

3. Work reflects the employee honors the Frazier Rehab Institute Mission Statement, Vision Statement, and Corporate Values. (Mandatory for all employees)

4. Demonstrates the knowledge and skills necessary to interact with and provide care appropriate to the age of the patients served. (Mandatory on all patient care positions)4.1 Demonstrates sensitivity to the age of the patient and/or family in all communication interactions.4.2 Demonstrates proficiency in the operation of equipment utilized to perform the essential function of the job.4.3 Demonstrates knowledge related to age appropriate behavior of adolescents, adults and geriatrics to assess the psychosocial needs of the patient.

5. Provide initial assessment upon a patient’s planned admission to any access point of the continuum of care, reflecting the patient/family’s current and anticipated healthcare, social, educational, financial and vocational needs and resources.5.1 Conducts initial assessment within 48 hours of a patient’s admission to the Hospital as evidenced by documentation.5.2 Demonstrates working knowledge and understanding of the injury, illness, disability and diagnosis as well as corresponding medical, developmental and /or educational needs both current and projected of the patient, as evidenced by documentation.5.3 Interprets and integrates data from interview with the patient and/or family, medical records and the rehab team in order to provide an accurate assessment of the patients’ current status and needs, as evidenced by documentation.5.4 Generates with the treatment team a set of recommendations that identify projected healthcare needs and/or educational recommendations that are congruent with the developmental stage of the patient, as evidenced by documentation.5.5 Relates initial recommendations and proposed treatment plan to the patient and/or family, as documented in the patient record.5.6 Provides the initial discharge planning recommendations to the treatment team prior to or during the first team rounds.5.7 Facilitates communication of initial assessment and treatment plan to third party payor contact within 24 hours of the first team rounds or as otherwise indicated by specific instructions.

6. Coordinates the overall discharge plan for the patient and family.6.1 Develops an integrated, comprehensive discharge plan in consultation with the patient, family and team, as documented in the patient record.6.2 Revises the discharge plan according to assessed changes in patient/family needs and rehab team recommendations, as documented in the patient record.6.3 C