Social Worker - Home Health

About the role

The Medical Social Worker is an integral part of the interdisciplinary team who provides assessment for the patient's social, emotional, environmental, financial, and support needs as related to the patient's illness. Provides diagnostic evaluation of psychosocial problems and defines social service goals for alleviating problems. Provides patient-centered interventions. Assesses risk factors or barriers to care and provides or refers appropriate services as indicated and provides discharge planning for appropriate patients and families. Serves as part of the interdisciplinary team and coordinates patient care with the primary nurse and other team members including patient/family.

Core Responsibilities

• Adheres to all applicable federal, state, and local regulations related to providing social work services.
• Demonstrates current knowledge of community resources appropriate to setting and population; refers to community resources as needed.
• Performs assessment, teaching, advocacy, and linkage with community resources and long-term care options for patients.
• Demonstrates effective assessment skills in identifying abuse and neglect, effective use of team to collect data, and demonstrates referral to appropriate intervening agency (e.g., Adult Protective Services) as necessary.
• Shows competency in assessing and intervening in patient/family adaptation and functional state.
• Facilitates agency contacts via phone or direct for patients/families requiring other forms of assistance, including program entitlements.
• Interfaces with area nursing homes, extended care facilities, and hospitals to facilitate transfer of patients, when appropriate.
• Participates in interdisciplinary conferences and staff meetings; initiates and participates in family meetings as appropriate.
• Responsible for discussing advance care planning with patient and family and communicating with team regarding end-of-life decisions and changes.
• Collaborates with the patient, family, and staff member in developing and implementing a plan of care within regulatory timeframe.
• Advocates for patients to resolve crises and intervene in crisis situations.
• Monitors and evaluates patient progress according to care plan; assesses and identifies environmental impediments to patient progress.
• Assists patients with health insurance companies, community health agencies, transportation services, and financial assistance programs and associated paperwork.
• Ensures that an assessment is completed and documented within regulatory timeframe.
• Maintains and submits productivity as requested.
• Participates in on-call rotation and presents education programs through various community events.

Requirements

• Education: Master's in Social Work
• Experience: One (1) year health care experience
• License/Registration/Certifications:
  • Valid SC Social Work License (LMSW - Licensed Master Social Worker OR LISW-CP - Licensed Independent Social Worker Clinical Practice)
  • Valid driver's license in good standing
  • BLS certification

Preferred Qualifications

• Three (3) years health care experience
• Home health and/or hospice experience

Physical and Cognitive Requirements

• Ability to withstand stress and demands of an active position.
• Stand, walk, stoop, kneel, bend, and sit for short or extended intervals.
• Lift and/or move in a push or pull manner more than 50 pounds occasionally to reposition patients whether seated, lying on a bed, or leaning against an object.
• Carry or lift objects such as medical equipment, laptop, and supplies.
• Ability to walk upstairs and on uneven surfaces.
• Extensive driving of personal or fleet car.
• Manual dexterity and good eye/hand coordination; full range of body motion.
• Acceptable vision and hearing needed in daily work.
• Ability to talk, read, hear, and write.
• Utilize language services for non-English speaking patients.
• Ensure proper handling of patient records to ensure compliance with patient health information applicable to the preservation, accuracy, and completeness of communication and/or retention of patient information, meeting all HIPAA regulations and the HITECH Act provisions as required by law.
• Maintain a current professional licensure (i.e., LMSW or LISW-CP) and maintain good standing with the SC Board of Social Work Examiners.