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Mass General Brigham

Boston, Massachusetts

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Penn Medicine

Bala Cynwyd, Pennsylvania

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UC Irvine Hospital Medicine & Palliative Medicine

Orange and Irvine, California

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KeystoneCare Homecare - Palliative - Hospice - Private Duty

Wyndmoor, Pennsylvania

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UCSF at Zuckerberg San Francisco General

San Francisco, California

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Lifesong Hospice and Palliative Care

Harrisburg, Pennsylvania

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University of Vermont- Family Medicine

Burlington, Vermont

Lehigh Valley Health Network

Allentown, Pennsylvania

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Lancaster, Pennsylvania

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Hospice & Community Care/Choices Healthcare

Lancaster, Pennsylvania

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Gilchrist Inova

Falls Church, Virginia

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Baltimore, Maryland

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Salt Lake City , Utah

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Long Island, New York

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Cleveland Clinic Cancer Institute

Akron, Ohio

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Billings Clinic (health system)

Billings, Montana

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Clinical Social Worker 2
Job DescriptionCare Coordination:Screen patients to identify needs and prioritize caseload to identify high risk and rising risk patients.Coordinate with interdisciplinary team to develop, revise, (if necessary due to change in patient progress), and implement appropriate discharge interventions to ensure safety and care coordination.Accepts responsibility for patients' Transitions of Care, coordinating provisions for discharge to including follow-up appointments, home health, community services, transportation, etc., in order to maintain continuity of care on identified high risk patients.Communicate with CRM manager any pertinent findings causing a delay in care coo


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