Baylor Scott & White Medical Center - Sunnyvale is an acute care hospital serving the communities in and around Sunnyvale, Texas. We strive to make the lives of our patients and their families better at every interaction. Our Team Members live out this passion in their daily roles as we support their career and personal goals. We are located just minutes east of Dallas and south of Garland / Rowlett on Hwy 80 at Collins Road in Sunnyvale. Many team members live in Forney, Mesquite, Garland, Balch Springs, and Rockwall areas with a short commute. Our work environment includes: Modern Office Setting On-Site Cafe' and Coffee Bar (Payroll Deduction available) Collaborative Teams Team Member engagement opportunities Competitive pay Benefits provided based on your work assignment (Full-time, Part-time, or PRN Baylor Scott & White Medical Center - Sunnyvale is seeking a Social Worker that 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 patient’s resources and right to self-determination. The individual in this position has overall responsibility for to assess the patient for transition needs including identifying and assessing patients at risk for readmission. 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: Transition Management promoting appropriate length of stay, readmission prevention, and patient satisfaction; Care Coordination by demonstrating throughput efficiency while assuring care is the right sequence and at appropriate level of care. Compliance with state and federal regulatory requirements, TJC accreditation standards, and Tenet policy; Education provided to physicians, patients, families, and caregivers; and Leads a population of patients by service line and/or leads the team by being a resource to Tenet performance standards. What your day will look like: This individual’s responsibility will include the following activities: complex psycho-social transition planning assessment and reassessment and intervention, assistance with adoptions, abuse and neglect cases, including assessment, intervention and referral as appropriate to local, state and /or federal agencies, care coordination, implementation or oversight of implementation of the transition plan, leading and/or facilitating multi-disciplinary patient care conferences including Complex Case Review, making appropriate referrals to other departments, communicating with patients and families about the plan of care, collaborating with physicians, office staff, and ancillary departments, assuring patient education is completed to support post-acute needs, timely complete and concise documentation in Case Management system, maintenance of accurate patient demographic and insurance information, precepts new staff members and acts as a resource to all staff, facilitates TEMPO as needed, participates in department quality improvement initiatives, and other duties as assigned. Success Factors: Masters or Bachelor degree of an accredited program of Social Work. Five years hospital experience is required. Experience with all age groups preferred. Licensed Medical Social Worker in the State of Texas Possess the ability to deal tactfully with staff, physicians, patients, families and visitors. Knowledge of TJC, CMS, TDH standards, community resources, and third party payor sources. 2503023299