JOB SUMMARY

The Social Worker is responsible for creating outcomes for the patient and family by managing complex psychosocial and economic co-morbidities. Provide education and consultation regarding resources, collaborate to develop a discharge plan and facilitate and monitor its implementation. Assist patient/family to adjust to and cope with illness, diagnosis, treatment options, and prognosis. Through advanced practice skills mobilizes resources to reduce risk, serves as a liaison between the hospital and the community. In addition offers crisis interventions to patient/family. Strives for superior performance by consistently providing a product or service to leadership and staff that is recognized as ultimately contributing to the patient and family experience. Recognizes and demonstrates understanding of patient and family centered care.

PRIMARY JOB RESPONSIBILITIES

Psychosocial Assessment and Interventions:

1. On the basis of preliminary risk screening, assesses patients and family’s psychosocial risk factors through evaluation of prior functioning levels, appropriateness and adequacy of support systems, reaction to illness and ability to cope.
2. Appropriately documents in medical record those patients identified as high risk for readmission.
3. Intervenes with patients and families regarding emotional, social, and financial consequences of illness and/or disability; accesses and mobilizes family/community resources to meet identified needs.
4. Provides intervention in cases involving child abuse/neglect, domestic violence, elder abuse, institutional abuse, and sexual assault.
5. Serves as a resource person and provided counseling and intervention related to treatment decisions and end-of-life issues.

Discharge Planning:

1. Participates in discharge planning activities for complex patients, in order to ensure a timely discharge and to provide appropriate linkage with post-discharge care providers.
2. Deals with families exhibiting complex family dynamics that impact directly on patient care and discharge.
3. Communicates with healthcare team regarding the discharge planning status of all patients referred by them.
4. Assists RN Case Managers or appropriate team members with discharge planning activities as requested.
5. Provides consultation to RN Case Manager or appropriate team members when coordination with significant or intensive community resources is necessary to achieve desired treatment outcomes.
6. Receives referrals for complex patient problem resolution from RN Case Managers or care team members.
7. Screens and coordinates referrals to the next level of care, SNF, LTAC, Hospice, and Rehab. Validates discharge criteria for patient and families and notifies RN Case Managers of newly-identified resources or change in previously-identified resources.
8. Educations patient/family and physician regarding post-acute options and addresses issues of choice.

Patient and Family Support in Legally Complex Cases:

1. Provides intervention in child abuse/neglect, domestic violence, guardianship (temporary/permanent), foster case, adoption, mental health placement, advance directives, adult/elderly abuse, child protection and sexual assault.
2. Ensures safe care to patients adhering to policies, procedures, and standards within budgetary specifications, including time management, supply management, productivity, and accuracy of practice.
3. Promotes individual professional growth and development by meeting requirements for mandatory/continuing education, skills competency, supports department-based goals which contribute to the success of the organization.
4. Actively participates in care conferences and multidisciplinary rounds.
5. Advocates for patient and family empowerments and independence to make autonomous health care decisions and access needed services within the health care system.
6. Actively participates in clinical performance improvement activities as assigned.
7. May provide supervision of Social Worker interns, MSW’s with less than 4,000 hours of hospital experience, ensuring requirements mandated by the State of Michigan. Provides mentorship to all levels of Social Work in current social trends and practice.
8. Maintains documentation of the Case Work process in the patient’s medical record to include problem statement, plan, interventions, and outcomes. Documents progress with active placement activities at least three (3) times/week. Records case work volume statistics as required by departmental leadership.
9. Arranges for and participates in coverage during short, long, and/or unexpected absences of self and other Case Management staff.
10. Demonstrates knowledge of and supports hospital mission, vision, value statements, standards, policies and procedures, operating instructions, confidentiality statements, corporate compliance plan, customer service standards, and the code of ethical behavior.

DEPARTMENTAL AND ADDITIONAL JOB RESPONSIBILITIES

1. Other duties as assigned

JOB SPECIFICATIONS

EDUCATION

1. Master’s prepared Social Worker with current licensure to practice medical social work in the state of Michigan (LMSW). If LLMSW, must obtain LMSW designation within 6 months of qualification to sit for exam.

EXPERIENCE

1. Two (2) years’ experience in a short term acute care hospital setting preferred.
2. Prior Case Management or health finance experience preferred.
3. Experiential knowledge of the post hospital place process preferred.

ESSENTIAL PHYSICAL ABILITIES/MOTOR SKILLS

These physical requirements are not exhaustive and additional job related physical requirements may be added on an as needed basis. Corrective devices may be used to meet physical requirements.

1. Sedentary Work: Frequently required to stand, kneel and crouch. On a daily basis may be required to move about, sit, climb stairs and bend. Is frequently required to lift and carry up to 20 lbs. May be required to push/pull/carry items between 20-100 lbs.
2. Vision: Requires the ability to perceive the nature of objects by the eye. Near acuity: Clarity of vision at 20 inches or less. Midrange Acuity: Clarity of vision at distances of more than 20 inches and less than 20 feet.
3. Motor Coordination: While performing the duties of the job, it is required to regularly perform functions that include using hand and finger movement, handle or feel objects, be able to use tools or equipment that requires reaching with hands and arms. Must be able to travel independently throughout the hospital; access patients/families including areas confined by space and/or equipment.
4. Speaking/Hearing: Ability to give and receive information through speaking and listening.

ESSENTIAL TECHNICAL ABILITIES

1. Proficiency using modern office, computer and telephone equipmentas used by Memorial Healthcare.

ESSENTIAL MENTAL ABILITIES

1. Ability to adapt and maintain focus in fast paced, quickly changing or stressful situations.
2. Ability to read and interpret a variety of documents including, but not limited to policies, operating instructions, white papers, regulations, rules and laws.

ESSENTIAL SENSORY REQUIREMENTS

1. Able to see for the purpose of reading information received in formats including but not limited to paper, computer, reports, bulletins, updates, manuals.
2. Able to hear for work-related purposes.

INTERPERSONAL SKILLS

1. Ability to interact with co-workers, hospital staff, administration, patients, physicians, the public and all internal and external customers in a professional and effective, courteous and tactful manner, at all times, physically, verbally and in all written and electronic communication.
2. Required to remain calm when adversity is encountered.
3. Open, honest, and tactful communication skills.
4. Ability to work as a team member in all activities.
5. Positive, cooperative and motivated attitude.