Care Coordinator, Social Worker at South Seminole Hospital
2 weeks ago
Position Summary:
Department:
SSH Care Management
Status:
Full-Time
Schedule:
Day
Title:
Care Coordinator, Social Worker ll
Located in Longwood, Florida, Orlando Health South Seminole Hospital is a comprehensive medical, surgical and behavioral health facility with 126 acute-care beds and 80 inpatient behavioral health beds.
It also provides a full range of outpatient services, including diagnostic and interventional radiology, nuclear medicine, laboratory, surgery, MRI, psychotherapy services and hyperbaric oxygen therapy for wound care.
Orlando Health South Seminole is proudly recognized among the nation's "Best Regional Hospitals" by U.S.News & World Report, "Great Community Hospitals" by Becker's Healthcare and "Best Places to Work" by Modern Healthcare, named for four consecutive years.
Orlando Health South Seminole is part of the Orlando Health system of care, which includes award-winning hospitals and ERs, specialty institutes, urgent care centers, primary care practices and outpatient facilities that span Florida's east to west coasts and beyond.
Collectively, our 27,000+ team members honor our over 100-year legacy by providing professional and compassionate care to the patients, families and communities we serve.
Orlando Health is committed to providing you with benefits that go beyond the expected, with career-growing FREE education programs and well-being services to support you and your family through every stage of life.
We begin your benefits on day one and offer flexibility wherever possible, so that you can be present for your passions.
"Orlando Health Is Your Best Place to Work" is not just something we say, it's our promise to you.Top Reasons to Choose Orlando Health - South Seminole Hospital:
South Seminole Hospital is Nationally Recognized for the BEST Places to Work
Benefits Package that begins on day one (Full-Time & Part-Time only).
Flexible Schedules
Tuition Reimbursement up to $5,000 a year.
Position Summary:
Collaborates with the assigned clinical team to identify patients most likely to benefit from care coordination services to include assessing patients' risk factors and the need for care coordination, clinical utilization management and preventative care services.
Responsibilities:
- Takes the lead in ensuring the continuity and consistency of care, across the continuum (inpatient, emergency and ambulatory care/ outpatient) to ensure integrated delivery across all settings to include the facilitation comprehensive discharge planning (in the hospital) and follow-up care (as an outpatient).
- Develops an effective working relationship with the Patient and Family Counselors/ Social Workers and the UR nurses to engage the patient/family to collaborate, advocate and problem solve, to support and enhance their functional ability, while ensuring an appropriate and timely discharge plan.
- Daily monitoring of progress towards discharge plans and/ or need to alter discharge plan due to change in patient condition / family needs with a priority placed on those patients at highest risk for complication/ admission/
- Educates patients/ families with chronic illness about evidence-based standards of care to include self-management strategies.
- Identifies support needs for patients and their families, develops action plan(s), and provides creative guidance in initiating and overcoming any self-management strategies.
- Educates patients and families about the health care system and facilitates relationship building between the various settings.
- Ensures patients have access to prescriptions, durable medical equipment (DME), and other services as identified.
- Contributes to problem solving within the team through communication, collaboration, data collection, obtaining consensus and evaluating outcomes of treatment options to include tracking patient progress towards care plan
- Advocates for patients in order to optimize their health care needs including but not limited to: safety, physical, legal and financial well-being.
- Refers patients to education regarding the healthcare delivery and reimbursement systems, prescription drug programs, health & wellness programs, community agencies, public and private organizations, housing options, and other services, as appropriate.
- Works with available IT resources (i.e. Phytel, Crimson) to facilitate registry reporting and maintenance of specified patient populations to improve disease outcome measures through evidence-based guidelines and the implementation of clinical decision support tools, referral and test tracking, and preventive medicine reminders.
- Participates in clinical outcome measurement to include the identification of strategies that promote population health.
- Ensures patient safety in the performance of job functions to include the implementation of policies, procedures and standards to support the assigned duties.
- Maintains reasonably regular, punctual attendance consistent with Orlando Health policies, the ADA, FMLA and other federal, state and local standards.
- Maintains compliance with all Orlando Health policies and procedures.
Qualifications:
Education/Training
Master's degree from an accredited school of Social Work, Mental Health, Psychology or Marriage and Family Therapy is required.
Licensure/Certification
None.
Experience
Two (2) years of direct clinical experience with an emphasis on the population to be served in the assigned area.
Successful completion of Master's level internship within the population to be served may substitute the two (2) years of experience.
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