Clin Social Wrkr IP/OP SS

UF Health•Gainesville, FL

3d•Onsite

About The Position

The Clinical Social Worker provides and coordinates psychosocial and behavioral services to her/his group of patients. She/he assesses, plans, implements and monitors a plan of care for her/his group of patients. This is done in collaboration with other members of the medical team, i.e. physicians, nurses, case managers, PT/OT staff, pharmacists. Works with the care team in a designated setting to identify, and, when possible, advocates for the patient; works to provide direct services, resources, and counseling that a patient/client needs to create a safe, effective and efficient transition/discharge from the hospital or clinic. Provides his/her expertise in a crisis intervention situation and assesses for potential abuse/neglect of vulnerable patients.

Requirements

Master's degree in Social Work (MSW) required from an institution accredited by the Council on Social Work Education
License-eligibility required for LCSW in the State of Florida
LCSW required within three years of hire, or when eligible based on hours worked, for all social workers hired after October 8, 2017.
Certification required within two years of specialty experience at UF Health Shands or certification eligibility date, for all social workers hired after October 8, 2017.
Recent clinical experience applicable to the designated population served.

Nice To Haves

LCSW preferred
Professional certification in specialty area preferred
Experience in a healthcare setting preferred

Responsibilities

Contributes to the development of the multidisciplinary plan of care of his/her assigned patients, focusing on the identification of needs, and the progression of care, while assuring the quality and appropriateness of care.
Completes an assessment on those patients she/he is consulted on, and/or those patients identified through "screens" developed to flag high-risk patients.
Performs a comprehensive evaluation including social, behavioral, emotional, mental status, environmental and financial assessment in conjunction with the interdisciplinary team on identified/consulted cases.
Selects an appropriate therapeutic modality for use with a patient/client to facilitate positive coping/adjustment behaviors, enhance compliance with prescribed treatments, participation in discharge planning and acceptance of responsibility for follow through with the post treatment plan.
Develops post-discharge care plans based on a comprehensive patient evaluation that allow for a safe and effective discharge.
Promotes optimal management of resources through regular and ongoing communication with the care team, and when appropriate, the utilization management staff.
Participates in the unit care coordination rounds to update the plan of care when needed.
Communicates regularly with the medical care team (physicians, nursing, PT/OT, Dietary, Respiratory, etc), to gather information from them on plans for the patient and provides information on resources available to them relative to discharge plans.
Plans for, participates in and in some cases leads patient/family care conferences to establish patient outcomes and evaluate patient care.
Works with the utilization management staff to assure that the patient is in the correct status and the requirements of the patient's insurance company are met.
During the patients visit and/or stay in the hospital, conducts an ongoing assessment and identifies process delays impacting the timeliness of patient care.
Communicates with the care team to impact on the utilization of resources, and any delays in care.
Collects and reports variances and avoidable days to managers and places the information in the departments tracking system.
Escalates cases to a physician advisor or a manager if his/her attempts to move a case along are not being addressed.
Facilitates an appropriate discharge for his/her patients in accordance with the patient's medical readiness and expected needs. Coordinates the discharge/transition of care for her/his patients to settings such as behavioral health facilities, hospice, home, substance abuse facilities etc.
Prepares the patient and/or family for discharge by providing an explanation of the plan and what the patient/family can expect.
The discharge is facilitated in accordance with regulatory requirements, patient/family choice, financial resources, and third party payor requirements.
Ensures a safe and effective handover to the next level of care by working closely with both hospital and clinic staff and external agency liaisons and care navigators.
Provides clinical Social Work Services to patients, families and others in times of need.
Provides counseling services in reaction to illness, end of life care and disability issues.
Provides crisis intervention and stabilization in both emergent and urgent situations.
Leads the medical team in the management of all protective services cases; this includes child and adult protective services cases, identification of abuse/neglect, mental capacity, support systems and living situations.
Makes recommendations and referrals based on an assessment of the situation and within the constraints of professional licensure.
Provides thorough and timely documentation in the medical record.
Documents findings, actions taken, and discharge arrangements made according to departmental guidelines and regulatory standards.
Prepares sufficient documentation to assure the efficient handoff of active cases per department policy.
Prepares reports and medical records for transfers, as required, and closes cases in electronic systems according to department guidelines.
Maintains her/his own clinical competency, ethical standards and/or certification requirements.
Meets requirements for the job, i.e. My Training, Vaccinations, etc.
Maintains a knowledge of and adherence to hospital and departmental policy, and to the NASW Code of Ethics.
Maintains a knowledge of case management, utilization management and discharge planning requirements specified by federal, state and insurance guidelines.
Serves as an educational resource to the medical team and others regarding the availability of community resources and the discharge planning process.