Discharge Planner - Home Care jobs in San Jose, CA

San Mateo Medical Center (SMMC) is seeking a highly-qualified Social Worker III - Discharge Planner/Case Manager to provide highly skilled, intensive discharge planning and case management to individuals and their families, and provide casework consultation within SMMC and to outside agencies.

The Social Worker III - Discharge Planner/Case Manager position will support SMMC to provide services related to discharge planning/case management on various units of the hospital, including the Medical/Surgical unit, Intensive Care Unit, Acute Psychiatry unit, Short Term Rehabilitation unit, Emergency Room, and Psychiatric Emergency Services. This includes needs assessment, assistance in financial resource management, crisis management, service delivery planning and follow up, and referrals to public, community-based services and programs. The candidate should be familiar with the rules and regulations governing skilled nursing and assisted living facilities. The ideal candidate will have direct experience working in an acute care hospital setting performing discharge planning, including appropriate documentation in accordance with all Medicare and Medi-Cal regulations, and should be experienced working with Electronic Medical Records (EMR) and LEAN principles.

The current vacancy is an on-site, Full-Time, Regular position. In addition to the regular vacancy, we also have an Extra-Help vacancy on site. Experience with psychiatric discharge planning is strongly preferred.

The ideal candidate will be:

• An experienced social worker with the ability to plan and execute complex treatment plans in a community- or acute care hospital-based setting.
• Experienced with Behavioral Health and Recovery Services (BHRS), as well as other mental health community programs.
• Knowledgeable of the systems of care related to older adults, mental health, substance abuse, developmental delay, pediatrics, primary care, palliative care, chronic illnesses, dialysis, conservatorship, and probation and parole.
• Able to work independently with little supervision and demonstrates a high degree of initiative.
• Knowledgeable of housing resources, their requirements for eligibility, and other community services such as In-Home Supportive Services (IHSS), Multipurpose Senior Services Program (MSSP), Institute on Aging (IOA), Health Plan of San Mateo (HPSM), BHRS, and Bridges to Wellness, and more.
• Knowledgeable about County benefit and entitlement programs, such as Medi-Cal and ACE.
• Experienced and comfortable working with the following populations: multi-cultural, homeless, chronic diseases, end-of-life, mental health, domestic violence, parolees, and substance abuse disorders.
• Experienced working with a diverse population (race, ethnicity, age, ability, language, nationality, socioeconomic status, gender, religion, and sexual orientation).
• Able to accurately assess for signs of adult and child abuse and be a mandated reporter.
• Able to work in a politically charged environment under high degrees of stress and meet all deadlines.
• Able to develop effective and positive working relationships with community partners such as Aging and Adult Services, BHRS, and HPSM.
• An effective communicator to a broad range of stakeholders, including doctors, nurses, conservators, health advocates, families, and patients.
• Able to remain calm during crisis situations and perform emergency crisis counseling for families and patients as needed.
• Experienced documenting in an EMR.
• Able to communicate clearly and concisely.
• Spanish-speaking preferred.

Examples Of Duties

Duties may include, but are not limited to the following:

• Provide information and assistance to patients of SMMC.
• Conduct initial screenings for patients and develop appropriate discharge/service plans to address identified issues.
• Provide skilled casework services to patients and their families.
• Schedule and conduct family care conference meetings with patients, families, and treatment team for short-term and long-term placement needs.
• Coordinate referrals, both internal and external, as part of the social service plan.
• Follow up on referrals and document outcomes as well as completion of items.
• Provide crisis intervention to patients and their families.
• Assist patients in meeting a variety of emergency needs, including financial, housing, and emotional crises.
• Assist patients with applications and securing of private and public benefits.
• Gather and maintain current information on community resources and disseminate this information to patients and staff.
• Maintain case files utilizing the electronic medical record.
• Work with the hospital's multidisciplinary team of staff to identify and address barriers to care, participate in quality assurance efforts such as outcome analysis, chart reviews, and patient and staff satisfaction efforts, and assist with maintenance of Center policies.
• Document interactions with patients/clients in EMR.
• Be a member of the Palliative Care Team.
• Work in the emergency room or any other areas in the hospital that social workers cover.

Qualifications

Education:

• Satisfactory completion of 36 semester units of Social Welfare and/or appropriate behavioral science courses.

Experience:

• Three years' experience performing duties comparable to those of a Social Worker II or higher in San Mateo County.

Substitution: Possession of a Master's Degree in Social Work from an accredited school of Social Work and two years' experience performing duties comparable to those of a Social Worker II or higher in San Mateo County.

Licensure/Certification :

• California class C driver license or equivalent.

Application/Examination

Open & Promotional. Anyone may apply. Current County of San Mateo and County of San Mateo Superior Court of California employees with at least six months (1040 hours) of continuous service in a classified regular, probationary, Confidential and Management extra-help/limited term, and SEIU or AFSCME represented extra help/limited term positions prior to the final filing date will receive five points added to their final passing score on this examination.

IMPORTANT: Applications for this position will only be accepted online. If you are currently on the County's website, you may click the “Apply” button above or below. If you are not on the County's website, please go to https://jobs.smcgov.org/ to apply. Online applications must be received by the Human Resources Department before midnight on the final filing date.

TENTATIVE RECRUITMENT SCHEDULE

Final Filing Date: Tuesday, April 30, 2024, 11:59 PM PST

Application Screening: Week of April 30, 2024

Civil Service/Panel Interviews: Week of May 13, 2024

Job Type: Full-time

Pay: $92,892.00 - $116,084.00 per year

Benefits:

• 401(k)
• 401(k) matching
• Dental insurance
• Employee assistance program
• Flexible schedule
• Health insurance
• Life insurance
• Paid time off
• Retirement plan
• Vision insurance

Schedule:

• 8 hour shift

Work Location: In person