The Social Worker is responsible to facilitate care along a continuum through effective resource coordination to help patients achieve optimal health, access to care and appropriate utilization of resources, balanced with the patientâ��s resources and right to self-determination.
The Social Worker in this position has overall responsibility for to assess the patient for transition needs including identifying and assessing patients at risk for readmission.
Social Worker conducts complex psycho-social assessment and intervention to promote timely throughput, safe discharge and prevent avoidable readmissions.
This position integrates national standards for case management scope of services including:
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