Job Description
The role supports patients in inpatient rehabilitation facilities by coordinating their transition from hospital to home or other care settings. Patients benefit from tailored psycho-social assessments that identify risks for readmission and promote safe discharges without repeat hospitalizations. The core function involves conducting complex evaluations, developing intervention plans, and ensuring patients receive appropriate resources under expanded coverage guidelines.
Tenet Healthcare owns Abrazo West Campus Hospital, which focuses on delivering exceptional patient care with modern facilities. The organization collaborates with physicians, families, and caregivers to enhance patient outcomes through structured education programs. Hospitals like this one handle thousands of cases annually, integrating national standards for case management.
Daily activities include performing psycho-social assessments and interventions for transitions, managing adoptions or neglect cases by referring to state and federal agencies. Professionals coordinate multidisciplinary care conferences, implement transition plans, and oversee teams through lead roles in service lines. They follow procedures from TJC accreditation standards and Arizona licensing requirements, while navigating challenges like volatile patient emotions during crises.
Compensation information is not specified in the posting. The position offers medical, dental, vision, and life insurance plans. Benefits include a 401(k) retirement plan with employer match, generous paid time off, health savings accounts, healthcare and dependent flexible spending accounts, employee assistance program, and employee discount program. Voluntary options cover pet insurance, legal services, accident and critical illness, long-term care, elder & childcare, and auto & home insurance. Professional development features continuing education and career advancement tracks.
Responsibilities
- Facilitate care along a continuum through resource coordination
- Assess patients for transition needs including readmission risks
- Conduct complex psycho-social assessment and intervention
- Promote timely throughput and safe discharge
- Prevent avoidable readmissions
- Transition Management promoting appropriate length of stay, readmission prevention and patient satisfaction
- Care Coordination demonstrating throughput efficiency while assuring care sequences at appropriate levels
- Compliance with state and federal regulatory requirements, TJC accreditation standards and Tenet policy
- Educaction provided to physicians, patients, families and caregivers
- Lead population of patients by service line
- Complex psycho-social transition planning assessment and reassessment and intervention
- Assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral
- Care coordination
- Implementation or oversight of transition plan
- Leading and/or facilitating multi-disciplinary patient care conferences
Requirements
- Master's of Social Work
- Arizona licensed social worker (LMSW) completed within 90 days of hire
- MIDAS and Curaspan training completed within first 90 days
- 2 years of acute hospital experience preferred
- Accredited Case Manager (ACM) preferred