This role will cover the Detroit area.

Job Summary: In collaboration with the interdisciplinary team (IDT), provides and facilitates acquisition of economic, social, and emotional support services to palliative care patients and their families/caregivers.

Essential Functions:

1. Serves as clinical liaison and relational conduit with external referral accounts, internal palliative team and patient/families. Responsible for the planning, organization and implementation of social work services to patients and families in the clinic and home setting, assuring that medically related emotional and social needs are addressed on an individual basis for the patient.
2. Responsible to assess needs of patients facing life limiting illnesses and facilitate plans with patient/family to promote effective care.
3. Maintains a current knowledge base of available community agencies and resources to facilitate appropriate referrals.
4. Establishes and maintains communication/collaboration with the Interdisciplinary Team and patient’s primary physician regarding patient mental or psychosocial condition, plan of care, and anticipated needs to ensure exceptional patient care.
5. Understands and is committed to the philosophy, goals, and objectives of the Hospice concept and can explain these to families requiring assistance in decision making for the best care possible for the patient’s and families.
6. Proactively maintains strong relationships and communication with all clinics and the Interdisciplinary Team to ensure exemplary patient care.
7. Actively engaged in communication with the palliative care physician to assess the needs of our community partners.
8. Assesses patient/family/caregiver social, emotional and financial factors to cope with the terminal illness and death; their psychosocial status; potential for risk of suicide and/or abuse or neglect; environment, resources, obstacles to maintaining safety; and caregiver’s ability to function adequately.
9. Identifies the developmental level of patient/family/caregiver and obstacles to learning or ability to participate in care of the patient.
10. Develops, implements and revises the plan of care based on a thorough psychosocial assessment and consultation with team members, patient and caregivers.
11. Evaluates patient for level of care changes (long term care, respite, discharge) when appropriate and assesses ability to accept the change.
12. Assesses and develops instructions and plan of care reflecting needs identified for homemaker assistance.
13. Identifies patient/family/caregiver needs when discharged or when level of care changes; evaluates patient/family/caregiver response to intervention(s) when discharged or when level of care changes.
14. Assesses the need for counseling related to risk assessment for pathological grief; provides counseling services to the patient/family/caregiver experiencing emotional, social and economic conflict; evaluates patient/family/caregiver response to psychosocial interventions.
15. Assesses and provides grief support and education to patients and their families/caregivers. Assesses special needs related to cultural diversity including communication, space, role of family members and special traditions.
16. Documents patient care following established organizational standards of documentation practice, and regulatory and licensure requirements, submits documentation in accordance with policy.
17. Works collaboratively with other IDT members, communicates complete and accurate information and assists team members in understanding the significant social and emotional factors related to care of patients and their caregivers.
18. Works collaboratively and actively participates in team functions, meetings, and acts as a resource for staff members and orientees when appropriate and/or requested.
19. Evaluates and monitors patient’s insurance coverage and options in assessing patient/caregiver ability to meet financial obligations and responds to third party payor requests. Offers appropriate internal and community resources and assists patients, caregivers and staff in acquiring and utilizing resources, as indicated.
20. Proactively problem solves and identifies solutions utilizing critical thinking skills.
21. Participates in internal and external education and training, quality improvement initiatives, in-services, development of protocols and standards and other activities to promote palliative care and hospice practice as well as personal and professional growth.
22. Utilizes allocated supplies and resources appropriately to ensure business outcomes are met.
23. Adjusts to changes in workload, schedules based on changing departmental/organizational priorities.
24. Adheres to organizational policies, procedures, code of conduct and all regulatory and legal requirements, and practices within the NASW Code of Ethics.
25. Adheres to C.A.R.E. Model of Service: courtesy, acknowledgement, response and empathy.

Qualifications:

1. A Master’s Degree in Social Work (MSW) obtained from a school of social work accredited by the Council of Social Work Education required. Possession of a current license to practice social work issued by the State of Michigan. A Licensed Masters Social Worker (LMSW) is highly preferred but will consider a Limited Licensed Masters Social Worker (LLMSW).
2. A minimum of one (1) year paid social work experience required. Previous experience with terminally ill persons is required, hospice experience preferred.
3. Must be able to read, write and speak English fluently and be able to effectively communicate orally and in writing in internal and external relationships for all essential job functions.
4. Ability to use technology (hardware and software) required of clinicians in their practice.
5. Must possess excellent interpersonal skills, sound judgment, effective organizational, prioritization and follow-through skills, attention to detail, tact, dependability, emotional intelligence and the ability to maintain confidentiality and promote positive, constructive relationships with communication and collaboration at all levels.
6. Proof of current tuberculin testing required. Patient contact will not be allowed until tuberculin clearance is documented.
7. The physical and sensory demands of the position include: vision, effective speech and hearing for extensive telephone contact; repetitive motion; traveling; driving or riding in motor vehicle; standing, sitting, walking, bending, reaching, and stretching; lifting up to forty five (45) pounds unassisted and the ability to assist in lifting patients using appropriate lifting techniques and/or devices.
8. Must have reliable transportation.
9. Must be eligible to work in the United States.