JOB TITLE: SOCIAL SERVICES WORKER (Salaried, DOE)
REPORTS TO: SOCIAL SERVICES DIRECTOR
GENERAL PURPOSE:
This individual provides medically-related social services to assist residents in maintaining or improving their ability to manage their physical, mental, and social needs. The social services worker serves as a resident advocate and works in coordination with the interdisciplinary team to conduct clinical assessments, identify resident needs, develop appropriate goals and care plan interventions, help residents/families navigate community systems and resources, and coordinate discharge plans.
JOB FUNCTIONS:
* Assists staff members in evaluating, understanding, and meeting resident psychosocial needs
* Functions as a resident advocate, upholds resident rights, promotes resident choice and dignity
* Helps residents/families deal with the impact of disability, illness, and transition to the SNF or alternative placement on individual and family functioning
* Conducts initial resident psychosocial assessments and social histories
* Evaluates resident cognition, mood, behavior, and discharge potential, then develops individualized care plans related to these areas
* Plans and implements interventions for resident mood and behavior issues, educates staff on approaches
* Problem-solves resident/family concerns and issues, assisting with orientation and adjustment to the facility
* Coordinates and leads care conferences upon admission, bi-annually, and as needed
* Intervenes in crisis situations
* Conducts resident and staff interviews required for MDS assessments and enters information timely
* Coordinates resident room moves
* Acts as the lost/missing items and grievance procedure representative
* Assists residents/families in accessing and understanding insurance benefits and state/federal programs such as Medicare/Medicaid, Social Security, VA
* Assists residents/families in understanding advanced directives, power of attorney, guardianship
* Supports residents/families around end-of-life issues including hospice referral
* Initiates referrals to mental health services and acts a liaison with providers
* Connects residents and families to appropriate community resources and helps them navigate systems
* Coordinates discharge planning which includes providing education/information on community living options and supports based on care needs, making referrals, and establishing services prior to discharge
* Acts as a task supervisor and mentor to social work students doing their practicum placement at the facility
* Meets charting and professional documentation requirements including assessments, care plan, timely social services progress notes, PASRR forms, and other required documentation
* Participates in required meetings and continuing education opportunities such as staff trainings and work committees
* Maintains confidentiality of all health information according to facility policy, HIPAA, and state/federal regulation
* Maintains current knowledge of and complies with facility, state, and federal guidelines
* Communicates with the Social Services Director and Resident Care Manager of the assigned floor, seeking consultation and assistance as needed
* Performs other duties as assigned by the Administrator or Social Services Director
PHYSICAL AND SENSORY REQUIREMENTS:
Mobility, grasping, fine hand coordination; ability to hear, read and write, communicate with residents, family, staff, and consultants; ability to instruct other staff, to understand and follow written and oral instructions; ability to remain calm in emergency situations and handle multiple tasks.
QUALIFICATIONS:
* Bachelor of Arts or Sciences degree; BSW or MSW preferred
* Experience in a health care setting and/or with older adults
* Proficiency in core clinical competencies including assessments, systems and community resource navigation, communication/education/support job functions
* Effective interpersonal skills and ability to work with an interdisciplinary team
* Ability to plan, organize, develop, and implement programs and goals to provide optimum resident care
* Proven written and oral communication skills
* Demonstrates professional work habits including regular attendance
* Working knowledge of computer technology
* Meets all local health regulations, including background checks and reference inquiry
* Must be capable of performing the essential functions of this job, with or without reasonable accommodation
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