RN Care Manager API
Core
Assist patients and families with complex psychosocial needs through psychosocial assessments, discharge planning, and coordination of care transitions.
Role type
RN Care Manager (Social Work)
Builds
Care transition plans and referrals to community agencies
Domain
Healthcare / Social Work
Deliverable
client delivery
Required skills
Psychosocial assessment, discharge planning, crisis intervention, grief and loss counseling, knowledge of community resources, knowledge of federal and state regulations
Preferred skills
Individual and family assessment, substance use disorder support, behavioral health concerns
Technologies
Electronic medical record systems
Responsibilities
Conduct psychosocial assessments with patients and families; Communicate with alternate sites of care and community agencies; Complete and document assessments and plans in the electronic medical record; Provide consultation and resources to the healthcare team; Maintain knowledge of community resources and regulations; Participate in stakeholder committees.