Inspire health. Serve with compassion. Be the difference. Job Summary Provides screening, assessment, planning, problem resolution, resource management, social work services, counseling and crisis management as they relate to the health care and discharge planning needs of the patient/family. Manages and collaborates in discharge planning for patients with simple and complex needs and coordinates with agencies providing post hospital care. Functions effectively as an interdisciplinary health care team member collaborating with other health care professionals to coordinate in assessing patient/family needs and developing a comprehensive plan of care, to coordinate and facilitate resolution of patient needs. Services are provided in accordance with accepted standards of professional practice and the policies and procedures of Prisma Health. Accountabilities DISCHARGE PLANNING 1. Screens patients using high risk indicators including but not limited to, frequent hospitalization, inadequate support systems, homelessness, abuse, neglect, exploitation, and domestic violence. 2. Assesses for immediate discharge planning needs and develops and coordinates a discharge plan as determined by the patient's medical condition, level of independence, functional capacity, family/social support systems, and financial resources. 3. Assesses for long term and/or future patient care needs by identifying probable changes in level of independence or functional capacity in collaboration with patient/family and interdisciplinary care team. Provide information and education on community resources to empower patient/family decision making. 4. Communicates the discharge plan to patient/family and the interdisciplinary care team by timely documentation in the medical record, active participation in discharge rounds, and/or verbal dialogue as appropriate. Collaborates with patient and family to develop the discharge plan. - 50% DOCUMENTATION Documentation in the medical record is legible and conforms to hospital and department policies and procedures including but not limited to discharge plan, weekly status updates or whenever changes in the plan occur. - 25% BEHAVIORAL HEALTH ASSESSMENT AND MANAGEMENT 1. Assesses patient's behavioral health needs in collaboration with physicians, psychiatrists, and other members of the mental health team. 2. Provides counseling, crisis intervention, and psychological assessments to patients/families with appropriate medical staff supervision. 3. Collaborates with internal and external resources to develop a short term and long term plan of care as appropriate. - 25% Supervisory/Management Responsibilities This is a non-management job that will report to a supervisor, manager, director or executive. Minimum Requirements Bachelor's Degree - Social Work or equivalent in related field of study, such as Psychology 1 year - Healthcare setting in which complex discharge planning and management of a 40 caseload required Required Certification/Registrations/Licenses Licensed Bachelor Social Work - LBSW LSW - Licensed Social Worker - LLSW Work Shift Day (United States of America) Location 3010 Farrow Rd Columbia Facility 3250 Sickle Cell 3010 Farrow 300A Department 32501000 Sickle Cell 3010 Farrow 200-Practice Operations Share your talent with us! Our vision is simple: to transform healthcare for the benefits of the communities we serve. The transformation of healthcare requires talented individuals in every role here at Prisma Health. Prisma Health is the largest not-for-profit health organization in South Carolina, serving more than 1.2 million patients annually. Our 32,000 team members are dedicated to supporting the health and well-being of you and your family. Our promise is to: Inspire health. Serve with compassion. Be the difference.