Social Worker (MSW), Care Management, Full Time, First Shift

About the Role

Social Workers serving in a variety of departments and clinics are responsible for responding to referrals from the interdisciplinary team. The role involves completing psychosocial assessments, developing and implementing a care plan that addresses patients' needs, promotes continuity of care, and facilitates transitions to the next level of care. Social Workers provide education, consultation, and serve as a liaison to the healthcare team regarding emotional, psychological, social, financial, and developmental aspects of patient and family care.

Location: Cincinnati, OH, United States

Qualifications

• Master of Social Work (MSW) from an accredited School of Social Work.
• Licensed by the State of Ohio Social Work Board (LSW, LISW, or LISW-S).
• For employees working in UCMC Psychiatric Services: NCI-APS (Nonviolent Crisis Intervention with Advanced Physical Skills) Certification must be obtained within 90 days of hire.
• Minimum 1-2 years of equivalent experience (3-5 years preferred).

Responsibilities

Engagement and Exploration

• Engage patients and/or their families in a helping process.
• Assess psychosocial and mental health needs to identify barriers to treatment, enhance health status, increase patient/family satisfaction, and improve resource utilization.
• Develop rapport with patients and families for ongoing support.
• Adhere to tasks and responsibilities specific to the department, service, or clinic.

Goal Development and Implementation

• Develop a comprehensive intervention plan in collaboration with the patient/family and healthcare team.
• Implement and monitor the care plan, including:
  • Providing individual/family counseling and social work intervention for complex crisis management, mental illness, adjustment to illness, material assistance, healthcare decision-making, sexual assault, domestic violence, partner violence, elder abuse, competency, and other psychosocial barriers.
  • Advocating, mediating, and negotiating to maintain or enhance patient health status, improve social supports, and ensure safe transitions across the care continuum.
  • Providing family education and education about Advance Care Planning, including assistance with Advance Directives paperwork.
  • Initiating referrals to community resources as indicated.
  • Facilitating the discharge process to home, nursing facilities, rehabilitation centers, LTAC, group homes, or other facilities.

Evaluation and Termination

• Summarize the care plan with the patient/family and address questions or concerns.
• Provide linkages to community resources and services.
• Participate in process improvements to evaluate patient outcomes.
• Identify barriers in service delivery systems.
• Assess transportation needs and arrange as appropriate.
• Facilitate referrals to disease-specific agencies, particularly for employment, financial resources, support services, and chemical dependency services.

Education and Consultation

• Provide consultation and training to medical staff and healthcare professionals on psychosocial issues related to illness and barriers to improved health status.
• Collaborate with coworkers and management to support the ongoing development of the Social Work Department.

Competency

• Participate in activities that enhance customer service and improve Press Ganey scores.
• Attend staff meetings, mandatory departmental in-service training, and continuing education sessions.
• Maintain positive working relationships and knowledge of community agencies and services.
• Ensure timely, clear, and concise documentation; write reports as needed.
• Respond to email requests and provide information as requested.
• Participate in quality and safety initiatives.