Case Management Social Worker / Nurse Case Manager - Weekday PRN

Coordinate discharge planning and post-acute care needs for assigned patients by conducting timely initial and follow-up assessments to identify medical, psychosocial, financial, and discharge barriers. Collaborate with physicians, nursing, social workers, and interdisciplinary team members to support patient progression while assisting with utilization management, medical necessity review, and appropriate patient status determination. Educate patients and families regarding discharge plans, community resources, and available support services, serving as a patient advocate while communicating barriers to discharge, delays, and payer concerns to the appropriate team members. Maintain accurate and timely documentation in accordance with hospital, state, federal, and regulatory guidelines. Support process improvement efforts related to length of stay, readmissions, discharge times, patient flow, and overall case management metrics. Provide excellent customer service and professional hand-off communication throughout the continuum of care.