In order to meet your unique needs, our Care Management team is made up of three departments.
Care Management Department
Our number one goal as an organization is to provide accessible care that will meet all of your specific needs. The RN care managers and social workers in our Care Management Department are committed to meeting that goal in ways that go beyond medical treatment and provide long-term support for your entire well-being.
The main services provided by this department include:
Discharge planning: This begins on the first day you or your loved one are admitted into our hospitals. Our care managers will work with your doctors and medical team to plan for your specific needs during and after treatment. We always want to ensure a safe and smooth transition out of the hospital.
Community resources: Our social workers want to completely understand your specific needs so they can help you get connected with the right resources after you leave our care. These resources often include health coverage information, food assistance, transportation and advanced directives.
Coordinating post-hospital care: Our care managers will coordinate any ongoing medical needs you might have, including medical equipment or placement in nursing facilities or home health care programs. We want to make sure you’re doing well after your stay and answer any questions you might have, so we will give you a call at home after your visit.
Supportive listening and crisis intervention: If you or a loved one are dealing with trauma, bereavement or psychiatric needs, our care managers will refer you to helpful support groups or counseling services.
If you or your loved one are considered a high-risk patient or have multiple conditions that could possibly lead to re-admission, our Care Coordination team is here to help. We’ll work with you and the rest of your care team to provide disease management, pre-visit planning and more.
Psychiatric Care Management:
When you or a loved one are receiving psychiatric treatment with us, you can focus on recovery and leave the care planning to us.
All our patients are assigned a social worker, who will work with our team of nurses, doctors and therapists to assist the patient in the following ways:
• Psychosocial assessments used to determine patient strengths and challenges
• Discharge planning
• Coordination within the mental health court system
• Supportive individual and family counseling
• Coordination with outpatient teams (if applicable)