All the benefits and perks you need for you and your family:

• Benefits from Day One
• Paid Days Off from Day One
• Whole Person Wellbeing Resources

Our promise to you:

Joining AdventHealth is about being part of something bigger. It's about belonging to a community that believes in the wholeness of each person, and serves to uplift others in body, mind and spirit. AdventHealth is a place where you can thrive professionally, and grow spiritually, by Extending the Healing Ministry of Christ. Where you will be valued for who you are and the unique experiences you bring to our purpose-minded team. All while understanding that together we are even better.

Schedule: FT/Days (8:30AM-5PM) (4 Single Weekend Shifts Per 6-Week Period)

Location: 601 East Rollins Street, Orlando, FL 32803

The community you'll be caring for:

• Located on a lush tropical campus, our flagship hospital, 1,368-bed AdventHealth Orlando.
• Serves as the major tertiary facility for much of the Southeast, the Caribbean and South America.
• AdventHealth Orlando houses one of the largest Emergency Departments and largest cardiac catheterization labs in the country.
• We are already one of the busiest hospitals in the nation, providing service excellence to more than 32,000 inpatients and 125,000 outpatients each year.

The role you'll contribute:

The Social Work Specialist intervenes with patients who have complex psychosocial needs, require assistance with
eligibility determination for social programs and funding sources and qualify for community assistance from a variety of
special funds and agencies, and/or require assistance with transitions of care or discharge planning. In addition, offer
crisis intervention to patients and families with psychosocial needs and coordinates and facilitates the development of a
discharge plan of care for high-risk patient populations. This role will receive referrals for individuals from at-risk
populations from interdisciplinary team members (including physicians, RN Care Managers, staff nurses, and other
members of the care team).

The Social Work Specialist, in collaboration with the patient/family, care manager nurses, nurses, physicians and the
interdisciplinary team, ensures patient-centered care coordination through the continuum of care. The Social Work
Specialist ensures efficient and cost-effective care through appropriate resources monitoring, and clinical care escalations.
The Social Work Specialist is under the general supervision of the Care Management Supervisor or Manager and is
responsible for patient evaluations of post-hospital needs; development of a transition of care plans and initiation of the
implementation of the transitions of care plans prior to the discharge of the patient. The Social Work Specialist is
responsible for optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient
satisfaction, patient safety, readmission prevention and length of stay management. The Social Worker communicates
daily with the interdisciplinary team during daily multidisciplinary rounds. Care coordination, discharge planning,
transitions of care planning and are core competencies of this role. The Social Work Specialist facilitates the
collaborative management of patient care across the continuum, intervening to remove barriers to timely and efficient care
delivery and reimbursement. The Social Work Specialist provides education to nurses, physicians and the
interdisciplinary team on issues related to utilization of resources, medical necessity, CMS CoP for Discharge Planning
and care coordination. The Social Work Specialist is knowledgeable of post-hospital care and services available to the
patient including, but not limited to the following: Home Health, Infusion Services, Durable Medical Equipment,
Palliative Care, Hospice, Outpatient Services, Transitions of Care Clinics, Transitional Care supportive programs and
clinics, follow up appointments, Skilled Nursing Facilities, Rehabilitation Services and Facilities and Community-based
Organizations. The Social Work Specialist adheres to departmental and system goals, objectives, policies and procedures
and ensures quality patient care and regulatory compliance. Actively participates in outstanding customer service and
accepts responsibility in maintaining relationships that are equally respectful to all.

The value you'll bring to the team:

• Establishes and documents, based on the predicted DRG and multidisciplinary team member's input, Anticipated Date
  of Transition (ADOT) and destination and updates, as needed.
• Actively participates in daily Multidisciplinary Rounds to review progression of care and discharge plan for all
  assigned patients.
• Proactively identifies patients who no longer meet medical necessity and escalates potential denials, documents
  avoidable days, and facilitates progression of care.
• Collaborates with Utilization Management staff for collaboration on patient status changes and medical necessity
  discussions.
• Assists with End-of-Life conversation, Living Wills, Advance Directives, Power of Attorney, Community DNR.

Qualifications
The expertise and experiences you'll need to succeed:

EDUCATION AND EXPERIENCE REQUIRED:

• Bachelors and 2+ years experience

LICENSURE, CERTIFICATION OR REGISTRATION PREFERRED:

• Master's in Social Work
• Care Management discharge planning experience
• Knowledge of state and federal guidelines pertinent to care management
• Minimum two (2) years experience in hospital/medical social work

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