Case Manager- Social Worker

Mission Regional Medical center Sebastian, TX

Using a multidisciplinary approach, the Social Worker/Patient Advocate assists patients – Neonates, Pediatrics, Adolescents, Adults, Older Adults and their significant others to cope with a multiplicity of social and emotional problems, many with particular reference to illness and the hospital setting, working to promote or enhance psychosocial functioning of the patient and family. Assist discharge planning. Meet with patients, physicians, and families throughout the facility. Communicates effectively in person and telephone with physicians, other healthcare staff, patients, families and external contacts. Assist with Discharge Planning by assessing needs, developing a plan and providing appropriate resources to facilitate the plan.


Responsible for the direct data collection and data assessment of the patient's condition and stability based on psychosocial assessments.

Identifies biophysical, psychosocial environmental, self-care, educational, spiritual and discharge needs of the patient as evidenced in the patient's medical record.

Responsible for the comprehensive initial assessment and ongoing reassessment of the patient's condition, stability and determination of psychosocial needs.

Collaborates with other professional disciplines to plan, implement, evaluate and revise the Plan of Care for each patient, as evidenced in the patient's medical record. The Plan of Care is discussed with and developed as a result of coordination with the patient/family/significant others when appropriate.

Devises Plan of Care using theories, methods and modalities consistent with education and training.

Responsible for management of patient throughout stay, including discharge planning and making collateral contacts with others involved in the patient's treatment.

Assesses and reports domestic violence, elder, dependant adult and child abuse.

Bases decisions on facts, clinical reasoning and sound judgment and seeks assistance when necessary.

Communicates with the Director on all pertinent decisions related to behavioral contracts, possible discharges or transfers.

Responsible for the evaluation of the patient's response to/effectiveness of the implementation of the Plan of Care.

Documents all significant contacts and services provided in the medical record.

Co-facilitates education/group therapy with ancillary personnel when needed.

Coordinates safe discharge plans and referrals for continuation of care.

Outpatient: Provides Alcohol and Drug Screening and Counseling. Inpatient: Provides Alcohol and Drug Screening and Counseling or makes a referral to CADC if available. & documents need for treatment on care plan.

Sets patient care priorities appropriately. Assigns personnel to patient care activities for effective utilization of skills and abilities within their job description, scope of practice and level of competency and equalize workloads of assigned personnel.

Participates in clinical record review.

Notifies Manager/Charge Nurse/Director/House Supervisor, immediately of significant problems or unusual incidents and when appropriate, takes action to intervene.

Provides crisis intervention and supportive counseling to patients/families.

Conducts support meetings for patients/families as indicated.

Facilitates process/education groups and completes requisite documentation as needed.

Attends and maintains mandatory training in safe patient handling, trained in safe lifting techniques, includes but not limited to 1) Appropriate use of lifting devices and equipment, 2) Five areas of body exposure: vertical, lateral, bariatric repositioning and ambulation, 3) Use of lifting devices to handle patients safely.

Performs other duties as assigned or required.



Bachelor's Degree in Social Work or related field, required. Minimum of one years' experience as a social worker in a hospital setting, preferred. Current BLS certification upon hire and maintained current.

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