What are the responsibilities and job description for the Clinical Social Worker LCSW - Community Connect Program position at Cedars-Sinai Health System?
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About the Community Connect Program
The Clinical Social Worker LCSW is part of Cedars-Sinai’s Office of Health Equity and works primarily with the Community Connect Program .
Community Connect is a cross-departmental program focused on improving patient health by addressing nonmedical factors that can influence health and well-being. Through assessment, care coordination, and connections to community-based providers and resources, the program helps patients navigate social needs and barriers that may impact their access to care.
The Community Connect team connects patients with healthcare services, social services, public benefits, and community resources, helping to improve access to care and advance health equity throughout the communities Cedars-Sinai serves.
What will you be doing in this role?
The Clinical Social Worker LCSW provides a full range of social work services in collaboration with other CSMC staff to meet the psychosocial and discharge planning needs of patients/families/significant others. Active participation in Department's continuing education/staff development programs. Involved in program planning in assigned service areas along with the organization of social work activities. Provides clinical social work services to patients and their families with psychosocial needs. To assure patients receive benefit from medical and/or psychiatric care and post-hospital planning. To be available to non-licensed staff as a clinical resource/mentor to assist with complex cases.
The Clinical Social Worker LCSW is responsible for the development, planning, implementation, and evaluation of all social service-related interventions for corresponding Departments. Responsible for identifying patients who have psycho/social needs on an inpatient or outpatient basis and for developing patient care goals and treatment plans as agreed upon by the patient's care team. Available to physicians and nurse case managers as a consultant for those patients with complex psychosocial needs and advance care planning.
- Responsible for Psychosocial evaluations -- identification of problems affecting optimal patient care and the development of a treatment plan.
- Responsible for crisis intervention and individual and family counseling.
- Interdisciplinary discussion of psychosocial implications of illness including consultation regarding treatments and resources designed to solve the problems of the patients.
- Evaluates and implements social service programs for patients with psycho/social issues focusing on seniors, catastrophic and chronically ill patients.
- Performs triage for patients within corresponding team(s) and assists in coordinating patient care delivery, including DPA/POSLT and documents pertinent information in the case management system.
- Implements transitions of care between inpatient and continued outpatient follow up and vice versa.
- Initiates and/or participates in team care conference to include patient, family and care providers.
- Evaluates daily caseload and assess achievement of long and short term goals; Modifies goals with providers and care team based upon patient outcomes.
- Compiles and presents statistics and reports relating to patient outcomes and document findings in the patients EMR.
- Follows up on communication to the referral source, IE, PCP, family member, case manager, home health personnel, community social worker, Health Plan, etc.
- Acts as the social services liaison for the department, particularly in the areas of: Advance Care Planning discussions, Complex discharge planning, Biopsychosocial assessments.
- Refers patients to agencies that provides supportive services optimizing patients health plan benefits. Provides alternatives for patients requiring specific services.
- Assists in arranging community resources (i.e. meals on wheels, transportation services, adult day care, and info-line) and in the long term planning for patients transitioning to institutional setting.
- Participates in advance care planning initiatives.
Job Info
Salary : $48