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LMSW SOCIAL WORKER TRANSITIONAL CARE MANAGEMENT Innovation Care Partners
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Full-time
- The comprehensive network encompasses six acute-care hospitals, an extensive medical group with primary, specialty and urgent care services, a cancer care network, outpatient surgery centers, clinical research, medical education, a foundation, an accountable care organization, community services and more.
- Learn more at HonorHealth.com. Responsibilities Job Summary The responsibility of the LMSW - Transitional Case Manager is to work with ICP patients and their families to assure a smooth transition following the discharge from the hospital.
- This position works collaboratively with the ICP Chief Medical Officer, HH providers, hospitals based specialists, HH case Managers, the Comprehensive care coordinators, post-acute facilities care coordinators, and other agencies as needed to create a smooth transition following discharge from either an acute care setting or post-acute setting.
- The LMSW - Transitional Case Manager collaborates with the primary physician and other health care team members in the development of the patient goals and action plan, ensuring the formulation of a realistic and definitive transitional care plans that represents the total care needs and resources of the patient/client and family.
- Working with the PCP or specialist, the LMSW - Transitional Care Coordinator assists in the coordination of medical services and with transitions between levels of care and makes appropriate referrals for community services for the patient and family/caregivers.
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